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1

Prolonged esophagitis after primary dysfunction of the pyloric sphincter in the rat and therapeutic potential of the gastric pentadecapeptide BPC 157.  

PubMed

Seven or fourteen days or twelve months after suturing one tube into the pyloric sphincter (removed by peristalsis by the seventh day), rats exhibit prolonged esophagitis with a constantly lowered pressure not only in the pyloric, but also in the lower esophageal sphincter and a failure of both sphincters. Throughout the esophagitis experiment, gastric pentadecapeptide BPC 157 (PL 14736) is given intraperitoneally once a day (10 microg/kg, 10 ng/kg, last application 24 h before assessment), or continuously in drinking water at 0.16 microg/ml, 0.16 ng/ml (12 ml/rat per day), or directly into the stomach 5 min before pressure assessment (a water manometer connected to the drainage port of a Foley catheter implanted into the stomach either through an esophageal or duodenal incision). This treatment alleviates i) the esophagitis (macroscopically and microscopically, at either region or interval), ii) the pressure in the pyloric sphincter, and iii) the pressure in the lower esophageal sphincter (cmH2O). In the normal rats it increases lower esophageal sphincter pressure, but decreases the pyloric sphincter pressure. Ranitidine, given using the same protocol (50 mg/kg, intraperitoneally, once daily; 0.83 mg/ml in drinking water; 50 mg/kg directly into the stomach) does not have an effect in either rats with esophagitis or in normal rats. PMID:17452811

Dobric, Ivan; Drvis, Petar; Petrovic, Igor; Shejbal, Drazen; Brcic, Luka; Blagaic, Alenka Boban; Batelja, Lovorka; Sever, Marko; Kokic, Neven; Tonkic, Ante; Zoricic, Ivan; Mise, Sandro; Staresinic, Mario; Radic, Bozo; Jakir, Ana; Babel, Jaksa; Ilic, Spomenko; Vuksic, Tihomir; Jelic, Ivan; Anic, Tomislav; Seiwerth, Sven; Sikiric, Predrag

2007-05-01

2

Comparison of sphincter of Oddi manometry, fatty meal sonography, and hepatobiliary scintigraphy in the diagnosis of sphincter of Oddi dysfunction  

Microsoft Academic Search

Background: Sphincter of Oddi dysfunction (SOD) afflicts approximately 1% to 5% of patients after cholecystectomy. The diagnostic standard for SOD is sphincter of Oddi manometry (SOM), a technically difficult, invasive test that is frequently complicated by pancreatitis. A sensitive and accurate noninvasive imaging modality is thus needed for the diagnosis of SOD. Quantitative hepatobiliary scintigraphy (HBS) and fatty meal sonography

Mark L. Rosenblatt; Marc F. Catalano; Eduardo Alcocer; Joseph E. Geenen

2001-01-01

3

Study of the interstitial cells of Cajal in infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

BACKGROUND & AIMS: The interstitial cells of Cajal form a network in close association with the smooth muscle of the gut. They are regarded as pacemaker cells and might be involved in motility disorders. Their distribution was studied in a common disorder with a dysfunction of the pyloric sphincter called infantile hypertrophic pyloric stenosis. METHODS: Specimens from 27 infants with

JM Vanderwinden; H Liu; MH De Laet; JJ Vanderhaeghen

1996-01-01

4

Monitoring of Erectile and Urethral Sphincter Dysfunctions in a Rat Model Mimicking Radical Prostatectomy Damage  

E-print Network

1 Monitoring of Erectile and Urethral Sphincter Dysfunctions in a Rat Model Mimicking Radical post-RP urethral sphincter and erectile dysfunctions, and non-invasive methods to assess erectile of Sexual Medicine 2012;9(11):2827-37" DOI : 10.1111/j.1743-6109.2012.02905.x #12;2 Keywords: erectile

Paris-Sud XI, Université de

5

Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction  

Microsoft Academic Search

Background & Aims: Patients with sphincter of Oddi dysfunction are at high risk of developing pancreatitis after endoscopic biliary sphincterotomy. Impaired pancreatic drainage caused by pancreatic sphincter hypertension is the likely explanation for this increased risk. A prospective, randomized controlled trial was conducted to determine if ductal drainage with pancreatic stenting protects against pancreatitis after biliary sphincterotomy in patients with

Paul R. Tarnasky; Yuko Y. Palesch; John T. Cunningham; Patrick D. Mauldin; Peter B. Cotton; Robert H. Hawes

1998-01-01

6

Pneumatic dilatation in patients with symptomatic diffuse esophageal spasm and lower esophageal sphincter dysfunction  

Microsoft Academic Search

Nine patients with severe symptoms of diffuse esophageal spasm and lower esophageal sphincter dysfunction who were unresponsive to medical therapy and bougienage dilatation were treated by forceful pneumatic dilatation. Treatment with pneumatic dilatation in eight of the nine patients produced a marked improvement in dysphagia and regurgitation (average follow-up of 37.4 months). Esophageal motility performed up to three years (average

E. C. Ebert; A. Ouyang; S. H. Wright; S. Cohen; W. H. Lipshutz

1983-01-01

7

Botulinum toxin for the treatment of chronic constipation in children with internal anal sphincter dysfunction  

Microsoft Academic Search

Internal anal sphincter (IAS) dysfunction is a cause of refractory constipation in children. The goal of this study was to\\u000a determine whether intrasphincteric injection of botulinum toxin is effective in the treatment of constipation in pediatric\\u000a patients with IAS dysfunction. A retrospective review was performed of 24 pediatric patients with intractable constipation.\\u000a All patients had abnormal anorectal manometry, with either

Katy Irani; Leonel Rodriguez; Daniel P. Doody; Allan M. Goldstein

2008-01-01

8

Pruritus ani: is anal sphincter dysfunction important in aetiology?  

PubMed Central

Forty-three patients whose principal symptom was pruritus ani were studied. Twenty-eight had anal disease, while in 15 no such disease could be shown. Maximum resting pressures and transient and sustained pressures of the anal canal in response to rectal distension were measured by manometry. Although the maximum resting pressure in the patients with no disease was about the same as that in the group with disease, the pressures recorded in response to rectal distension were significantly lower. These results show that the anal sphincter relaxes in response to rectal distension more readily in patients with no anal disease. Hence soiling may occur, which may be a factor in the genesis of pruritus ani. PMID:534862

Eyers, A A; Thomson, J P

1979-01-01

9

Sphincter of Oddi dysfunction: Managing the patient with chronic biliary pain  

PubMed Central

Sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to functional obstruction of pancreaticobiliary flow at the level of the sphincter of Oddi. The Milwaukee classification stratifies patients according to their clinical picture based on elevated liver enzymes, dilated common bile duct and presence of abdominal pain. Type I patients have pain as well as abnormal liver enzymes and a dilated common bile duct. Type II SOD consists of pain and only one objective finding, and Type III consists of biliary pain only. This classification is useful to guide diagnosis and management of sphincter of Oddi dysfunction. The current gold standard for diagnosis is manometry to detect elevated sphincter pressure, which correlates with outcome to sphincterotomy. However, manometry is not widely available and is an invasive procedure with a risk of pancreatitis. Non-invasive testing methods, including fatty meal ultrasonography and scintigraphy, have shown limited correlation with manometric findings but may be useful in predicting outcome to sphincterotomy. Endoscopic injection of botulinum toxin appears to predict subsequent outcome to sphincterotomy, and could be useful in selection of patients for therapy, especially in the setting where manometry is unavailable. PMID:16804961

Bistritz, Lana; Bain, Vincent G

2006-01-01

10

Pyloric stenosis  

MedlinePLUS

Congenital hypertrophic pyloric stenosis; Infantile hypertrophic pyloric stenosis; Gastric outlet obstruction ... intestine through a valve called the pylorus. With pyloric stenosis, the muscles of the pylorus are thickened. This ...

11

Botulinum Toxin Injection for the Treatment of Upper Esophageal Sphincter Dysfunction  

PubMed Central

Objectives We sought to review the dysphagia-related outcomes and quality of life in a series of patients with upper esophageal sphincter (UES) dysfunction treated with cricopharyngeal (CP) botulinum toxin (BTX) injection, and to identify patient characteristics or CP muscle histologic features that predict efficacy of BTX injection. Methods A retrospective chart review was performed on patients with UES dysfunction who underwent CP BTX injection. Dysphagia-related quality-of-life questionnaires based on the Eating Assessment Tool (EAT-10) were mailed to patients. Results Forty-nine patients (30 female, 19 male; average age, 59 ± 16 years) with UES dysfunction have been treated at our institution with CP BTX injection since 2000. Seventeen of these patients also underwent CP myotomy. Injections of BTX were occasionally repeated after the treatment effect subsided, and the BTX dose varied widely (average, 39 ± 19 units). Improvement in symptoms was noted by 65% of patients. The overall complication rate was minimal, although many patients complained of transient worsening of dysphagia after CP BTX injection. Biopsy specimens of the CP muscle were evaluated in the subset of patients with CP BTX injection who proceeded to myotomy, with results of neuropathic, myopathic, and mixed histologic subtypes. The EAT-10 scores demonstrated a general trend toward improved swallowing outcomes after CP BTX injection. Conclusions This study reviewed findings from the largest published series of BTX treatment of UES dysfunction and evaluated the efficacy, patient satisfaction, and complications of this procedure. Dysphagia-related quality-of-life outcomes appear to be improved after CP BTX injection. PMID:23534124

Kelly, Elizabeth A.; Koszewski, Ian J.; Jaradeh, Safwan S.; Merati, Albert L.; Blumin, Joel H.; Bock, Jonathan M.

2014-01-01

12

Pyloric stenosis  

Microsoft Academic Search

Infantile pyloric stenosis is the most frequently encountered infant gastrointestinal obstruction in most general hospitals.\\u000a Although the primary therapy for pyloric stenosis is surgical, it is essential to realize that pyloric stenosis is a medical\\u000a and not a surgical emergency. Preoperative preparation is the primary factor contributing to the low perioperative complication\\u000a rates and the necessity to recognize fluid and

Bruno Bissonnette; Patrick J. Sullivan

1991-01-01

13

Hypertrophic pyloric stenosis: Ultrastructural abnormalities of enteric nerves and the interstitial cells of Cajal  

Microsoft Academic Search

Dysfunction of pyloric inhibition has been implicated in the pathophysiology of hypertrophic pyloric stenosis. Normal inhibition likely is mediated by peptideric enteric nerves and also may involve interstitial cells of Cajal (ICC). The authors used electron microscopy to qualitatively assess these structures in infants with pyloric stenosis and in normal controls. Pyloric muscle strips from five infants with hypertrophic pyloric

Jacob C. Langer; Irene Berezin; Edwin E. Daniel

1995-01-01

14

Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome?  

Microsoft Academic Search

A potential association between abnormal electromyographic activity--that is, decelerating bursts and complex repetitive discharges--of the urethral sphincter and difficulty in voiding was examined in 57 women with urinary retention. Abnormal electromyographic activity was found in 33. Ultrasonography of the ovaries in 22 of the 33 women showed that 14 had polycystic ovaries. Of the other eight women, two had had

C. J. Fowler; T. J. Christmas; C. R. Chapple; H. F. Parkhouse; R. S. Kirby; H. S. Jacobs

1988-01-01

15

BPC 157 therapy to detriment sphincters failure-esophagitis-pancreatitis in rat and acute pancreatitis patients low sphincters pressure.  

PubMed

Possibly, acute esophagitis and pancreatitis cause each other, and we focused on sphincteric failure as the common causative key able to induce either esophagitis and acute pancreatitis or both of them, and thereby investigate the presence of a common therapy nominator. This may be an anti-ulcer pentadecapeptide BPC 157 (tested for inflammatory bowel disease, wound treatment) affecting esophagitis, lower esophageal and pyloric sphincters failure and acute pancreatitis (10 ?g/kg, 10 ng/kg intraperitoneally or in drinking water). The esophagitis-sphincter failure procedure (i.e., insertion of the tubes into the sphincters, lower esophageal and pyloric) and acute pancreatitis procedure (i.e., bile duct ligation) were combined in rats. Esophageal manometry was done in acute pancreatitis patients. In rats acute pancreatitis procedure produced also esophagitis and both sphincter failure, decreased pressure 24 h post-surgery. Furthermore, bile duct ligation alone immediately declines the pressure in both sphincters. Vice versa, the esophagitis-sphincter failure procedure alone produced acute pancreatitis. What's more, these lesions (esophagitis, sphincter failure, acute pancreatitis when combined) aggravate each other (tubes into sphincters and ligated bile duct). Counteraction occurred by BPC 157 therapies. In acute pancreatitis patients lower pressure at rest was in both esophageal sphincters in acute pancreatitis patients. We conclude that BPC 157 could cure esophagitis/sphincter/acute pancreatitis healing failure. PMID:22204800

Petrovic, I; Dobric, I; Drmic, D; Sever, M; Klicek, R; Radic, B; Brcic, L; Kolenc, D; Zlatar, M; Kunjko, K; Jurcic, D; Martinac, M; Rasic, Z; Boban Blagaic, A; Romic, Z; Seiwerth, S; Sikiric, P

2011-10-01

16

Sphincter of Oddi Dysfunction  

MedlinePLUS

... that may help decrease pain. There have been studies of other medical therapies, such as calcium channel blocking drugs. Despite a few encouraging reports, these methods have not proven to be effective generally, and are not widely used. Patients who ...

17

Pyloric stenosis: congenital or acquired?  

Microsoft Academic Search

Pyloric muscle dimensions were measured in 1400 consecutive newborn infants. Nine of these subsequently developed pyloric stenosis. Their pyloric measurements at birth were all within the normal range. Congenital preformed muscular hypertrophy does not appear to be present in babies who later develop pyloric stenosis.

M D Rollins; M D Shields; R J Quinn; M A Wooldridge

1989-01-01

18

Pyloric stenosis: evolution from pylorospasm?  

Microsoft Academic Search

Over a 10-year period, we have performed pyloromyotomy on 260 infants with hypertrophic pyloric stenosis (HPS), 10 of whom had a history suggestive of pyloric stenosis but initially had neither the physical nor radiological findings to confirm the diagnosis. All 10 demonstrated pylorospasm on upper gastrointestinal series (UGIS), were treated medically without improvement, and subsequently developed classic HPS confirmed by

John R. Wesley; Michael A. DiPietro; Arnold G. Coran

1990-01-01

19

Congenital hypertrophic pyloric stenosis.  

PubMed

Congenital hypertrophic pyloric stenosis, an important cause of intractable vomiting in infants is diagnosed clinically and confirmed ultrasonographically. Other useful interventions are plain radiography and barium study. Differential diagnosis includes pylorospasm and gastroesophageal reflux. Management protocol includes correction of dehydration and electrolyte imbalance and either Fredet Ramstedt pyloromyotomy or medical treatment with atropine sulphate. Atropine is initially given intravenously till vomiting is controlled and then orally at double the effective i.v. done for another 3 weeks. Atropine sulphate is generally well tolerated and side effects are few like tachycardia, raised SGPT and hyperthermia. Atropine sulphate is very effective, cheap, safe and perhaps more acceptable treatment option for CHPS. PMID:12356225

Singh, Utpal Kant; Kumar, Ranjeet

2002-08-01

20

Electrophysiology of motor pathways for sphincter control in multiple sclerosis.  

PubMed Central

The central and peripheral motor pathways serving striated sphincter muscle function were studied using cortical and lumbar transcutaneous electrical stimulation, pudendal nerve stimulation and sphincter electromyography in 23 patients with multiple sclerosis (MS), and sphincter disturbance, including incontinence of urine or faeces, urinary voiding dysfunction, or constipation. The central motor conduction time was significantly increased in the MS group compared to controls (p less than 0.05). Damage to both the upper and lower motor neuron pathways can contribute to sphincter disturbance in MS. The latter may be due to coexisting pathology or to involvement of the conus medullaris by MS. PMID:2178181

Mathers, S E; Ingram, D A; Swash, M

1990-01-01

21

Electrophysiology of motor pathways for sphincter control in multiple sclerosis.  

PubMed

The central and peripheral motor pathways serving striated sphincter muscle function were studied using cortical and lumbar transcutaneous electrical stimulation, pudendal nerve stimulation and sphincter electromyography in 23 patients with multiple sclerosis (MS), and sphincter disturbance, including incontinence of urine or faeces, urinary voiding dysfunction, or constipation. The central motor conduction time was significantly increased in the MS group compared to controls (p less than 0.05). Damage to both the upper and lower motor neuron pathways can contribute to sphincter disturbance in MS. The latter may be due to coexisting pathology or to involvement of the conus medullaris by MS. PMID:2178181

Mathers, S E; Ingram, D A; Swash, M

1990-11-01

22

How should the pyloric submucosal mass coexisting with hypertrophic pyloric stenosis be treated?: a case of pyloric ectopic pancreas with hypertrophic pyloric stenosis.  

PubMed

Co-existing pyloric submucosal masses with hypertrophic pyloric stenosis (HPS) are very rare and treating these lesions is always a problem. A 20-day-old boy presented with recurrent episodes of projectile non-bilious vomiting lasting for 5 days. HPS was suspected due to the presenting age and the symptoms. The sonography demonstrated not only circumferential wall thickening of the pylorus, but also a pyloric submucosal mass. At laparotomy, a 0.8 cm sized pyloric submucosal mass was identified along with a hypertrophied pylorus. Pyloric excision was performed due to the possibility of sustaining the symptoms and malignancy. The pathological report of the submucosal mass was ectopic pancreas. Coexisting pyloric lesions can be diagnosed along with HPS, and surgical excision, not just pyloromyotomy, should be considered in these circumstances. To the best of our knowledge, this is the first case report of pyloric ectopic pancreas and HPS to be diagnosed concurrently. PMID:25349837

Kim, Soo-Hong; Yoo, Tae-Kyung; Kim, Hyun-Young; Jung, Sung-Eun; Park, Kwi-Won

2014-09-01

23

How Should the Pyloric Submucosal Mass Coexisting with Hypertrophic Pyloric Stenosis Be Treated?: A Case of Pyloric Ectopic Pancreas with Hypertrophic Pyloric Stenosis  

PubMed Central

Co-existing pyloric submucosal masses with hypertrophic pyloric stenosis (HPS) are very rare and treating these lesions is always a problem. A 20-day-old boy presented with recurrent episodes of projectile non-bilious vomiting lasting for 5 days. HPS was suspected due to the presenting age and the symptoms. The sonography demonstrated not only circumferential wall thickening of the pylorus, but also a pyloric submucosal mass. At laparotomy, a 0.8 cm sized pyloric submucosal mass was identified along with a hypertrophied pylorus. Pyloric excision was performed due to the possibility of sustaining the symptoms and malignancy. The pathological report of the submucosal mass was ectopic pancreas. Coexisting pyloric lesions can be diagnosed along with HPS, and surgical excision, not just pyloromyotomy, should be considered in these circumstances. To the best of our knowledge, this is the first case report of pyloric ectopic pancreas and HPS to be diagnosed concurrently. PMID:25349837

Kim, Soo-Hong; Yoo, Tae-Kyung; Jung, Sung-Eun; Park, Kwi-Won

2014-01-01

24

Prosthetic Sphincter Controls Urination  

NASA Technical Reports Server (NTRS)

People who lost muscular control of urinary canal through disease or injury aided by prosthetic sphincter. Implanted so it surrounds uretha, sphincter deflated and inflated at will by wearer to start and stop urina tion. Operating pressure adjusted after implantation to accommodate growth or atrophy of urinary canal and prevent tissue damage from excess pressure. Principle adapted to other organs, such as colon, ureter, or ileum.

Tenny, John B., Jr

1986-01-01

25

Internal anal sphincter augmentation and substitution  

PubMed Central

There is an increasing recognition of the importance of internal anal sphincter (IAS) dysfunction presenting as passive faecal incontinence. This problem may manifest after anal sphincterotomy or following the more minimally invasive operations for haemorrhoids, as well as with advancing age. Because of the poor results of IAS plication and the beneficial outcomes with peri-urethral bulking agents in urology, these materials have been developed for use in IAS dysfunction. This review outlines the basic purported mechanisms of action, defining the materials in clinical use, their methods of deployment, complications and reported outcomes. There is still much that is unknown concerning the ideal agent or the volume and the technique of deployment, which will only be answered by powerful, prospective, randomized, controlled trials. The specific role of autologous stem cells designed to regenerate the sphincters in cases of functional impairment or muscle loss is yet to be seen. PMID:24759338

de la Portilla, Fernando

2014-01-01

26

Internal anal sphincter augmentation and substitution.  

PubMed

There is an increasing recognition of the importance of internal anal sphincter (IAS) dysfunction presenting as passive faecal incontinence. This problem may manifest after anal sphincterotomy or following the more minimally invasive operations for haemorrhoids, as well as with advancing age. Because of the poor results of IAS plication and the beneficial outcomes with peri-urethral bulking agents in urology, these materials have been developed for use in IAS dysfunction. This review outlines the basic purported mechanisms of action, defining the materials in clinical use, their methods of deployment, complications and reported outcomes. There is still much that is unknown concerning the ideal agent or the volume and the technique of deployment, which will only be answered by powerful, prospective, randomized, controlled trials. The specific role of autologous stem cells designed to regenerate the sphincters in cases of functional impairment or muscle loss is yet to be seen. PMID:24759338

de la Portilla, Fernando

2014-05-01

27

The changing presentation of pyloric stenosis  

Microsoft Academic Search

Metabolic abnormalities described in pyloric stenosis are now rare, probably because of prompter recognition of the disease. This report reviews the trend in presentation over three decades. All infants treated for pyloric stenosis during three mid-decade target periods were reviewed. Comparison between the 1975 group and the 1985 group and between the 1995 group and previous decades were designed to

Konstantinos Papadakis; E. Alexandria Chen; François I Luks; Marc S Lessin; Conrad W Wesselhoeft; Frank G Deluca

1999-01-01

28

Pyloric muscle in asymptomatic infants: sonographic evaluation and discrimination from idiopathic hypertrophic pyloric stenosis  

Microsoft Academic Search

Objective. To compare the morphological and functional US appearance of the pylorus in healthy infants with those suffering from idiopathic\\u000a hypertrophic pyloric stenosis (IHPS) in order to determine the pathological limits and to find out the most discriminating\\u000a morphometric parameter. Materials and methods. The pylorus of 84 asymptomatic infants was prospectively evaluated with respect to morphology (pyloric length, pyloric diameter,

Wiltrud K. Rohrschneider; Henry Mittnacht; Kassa Darge; Jochen Tröger

1998-01-01

29

Prosthetic urinary sphincter  

NASA Technical Reports Server (NTRS)

A pump/valve unit for controlling the inflation and deflation of a urethral collar in a prosthetic urinary sphincter device is described. A compressible bulb pump defining a reservoir was integrated with a valve unit for implantation. The valve unit includes a movable valve member operable by depression of a flexible portion of the valve unit housing for controlling fluid flow between the reservoir and collar; and a pressure sensing means which operates the valve member to relieve an excess pressure in the collar should too much pressure be applied by the patient.

Helms, C. R.; Smyly, H. M. (inventors)

1981-01-01

30

Clinical diagnosis of pyloric stenosis: a declining art  

Microsoft Academic Search

OBJECTIVE--To assess whether diagnostic imaging of pyloric stenosis has made a difference in rapidity of diagnosis, duration of pre-operative hydration, and length of stay in hospital. DESIGN--Chart review of infants with confirmed diagnosis of pyloric stenosis. SETTING--Paediatric teaching hospital. SUBJECTS--215 infants with a confirmed diagnosis of pyloric stenosis seen during 1974-7 and 187 infants with pyloric stenosis seen during 1988-91.

J Macdessi; R K Oates

1993-01-01

31

An experimental model of prolonged esophagitis with sphincter failure in the rat and the therapeutic potential of gastric pentadecapeptide BPC 157.  

PubMed

We report a simple novel rat model that combines prolonged esophagitis and parallel sphincters failure. The anti-ulcer gastric pentadecapeptide BPC 157, which was found to be stable in gastric juice, and is being evaluated in inflammatory bowel disease trials, is an anti-esophagitis therapy that recovers failed sphincters. Twelve or twenty months after the initial challenge (tubes sutured into sphincters for one week and then spontaneously removed by peristalsis), rats exhibit prolonged esophagitis (confluent hemorrhagic and yellowish lesions, thinner epithelium and superficial corneal layer, with stratification derangement); constantly lowered pressure of both sphincters (assessed by using a water manometer connected to the drainage port of a Foley catheter implanted into the stomach either through esophageal or duodenal incision); and both lower esophageal and pyloric sphincter failure. Throughout the esophagitis experiment, BPC 157 was given at either 10 micro g/kg, i.p., once a day (last application 24 h before assessment) or alternatively, it was given continuously in drinking water at 0.16 micro g/ml (12 ml/rat). This treatment recovers i) esophagitis (macroscopically and microscopically, at either region or investigated time period) and ii) pressure in both sphincters (cmH2O). In addition, BPC 157 (10 micro g/kg) or saline (1 ml/rat, 5 ml/kg) was specifically given directly into the stomach; pressure assessment was performed at 5 min thereafter. The effect of BPC 157 is specific because in normal rats, it increases lower esophageal sphincter-pressure, but decreases pyloric sphincter-pressure. Ranitidine, given as the standard drug using the same protocol (50 mg/kg, i.p., once daily; 0.83 mg/ml in drinking water; or 50 mg/kg directly into the stomach) had no effect. PMID:17116974

Petrovic, Igor; Dobric, Ivan; Drvis, Petar; Shejbal, Drazen; Brcic, Luka; Blagaic, Alenka Boban; Batelja, Lovorka; Kokic, Neven; Tonkic, Ante; Mise, Stjepan; Baotic, Tomislav; Staresinic, Mario; Radic, Bozo; Jakir, Ana; Vuksic, Tihomir; Anic, Tomislav; Seiwerth, Sven; Sikiric, Predrag

2006-11-01

32

Infantile hypertrophic pyloric stenosis: myopathic type  

Microsoft Academic Search

Smooth muscle cell biopsies obtained at pyloromyotomy from 37 children with infantile hypertrophic pyloric stenosis (IHPS) were studied by light and electron microscopy and compared with 6 autopsy control cases without any clinical evidence of this disorder. In cases with IHPS an apparently irregular increase in the number of smooth muscle cells by mitosis was accompanied by an increase of

R. Dieler; J. M. Schröder; H. Skopnik; G. Steinau

1990-01-01

33

Atropine sulphate: rescue therapy for pyloric stenosis.  

PubMed

Infantile hypertrophic pyloric stenosis (IHPS) is a common condition which presents with non-bilious vomiting and failure to thrive secondary to gastric outlet obstruction. In the UK, management is by fluid resuscitation followed by pyloromyotomy. Incomplete myotomy complicates 0.3% of cases necessitating further surgery and exposing the patient to further risk. Medical management of IHPS with antimuscarinics to promote pyloric relaxation is a well-described treatment modality that is used as first-line therapy in some countries. The use of this technique is limited by the need for extended hospital admission with parenteral nutrition administration. We describe a case of IHPS complicated by incomplete pyloromyotomy and subsequently managed successfully by atropine sulphate therapy. PMID:22865807

Owen, Richard Peter; Almond, Sarah L; Humphrey, Gill M E

2012-01-01

34

An instant rare complication: a fractured metallic pyloric stent.  

PubMed

Metallic pyloric stenting (also termed as metallic enteral stenting) performed endoscopically, stands as first-line treatment for malignant gastric outlet obstruction. With reported evidence, these self-expandable metallic stents (SEMS) re-enable oral food intake, preventing patients having to face invasive techniques such as surgical gastroenterostomy. We report a patient having received a covered pyloric SEMS insertion following a tumour growth causing stenosis in the gastric antropyloric region. After 3 weeks, the patient presented with a fracture of the pyloric SEMS, a rare complication, resulting in a second pyloric SEMS insertion. PMID:23345482

Javaid, Mahvesh Rana; Yusuf, Aasim Mohammad

2013-01-01

35

Physiological and Functional Evaluation of the Transposed Human Pylorus as a Distal Sphincter  

PubMed Central

Background/Aims Studies evaluating the human pylorus as a sphincter are scanty and contradictory. Recently, we have shown technical feasibility of transposing the human pylorus for end-stage fecal incontinence. This unique cohort of patients provided us an opportunity to study the sphincter properties of the pylorus in its ectopic position. Methods Antro-pylorus transposition on end sigmoid colostomies (n = 3) and in the perineum (n = 15) was performed for various indications. Antro-pylorus was assessed functionally (digital examination, high resolution spatiotemporal manometry, barium retention studies and colonoscopy) and by imaging (doppler ultrasound, MRI and CT angiography) in its ectopic position. Results The median resting pressure of pylorus on colostomy was 30 mmHg (range 28-38). In benign group, median resting pressure in perineum was 12.5 mmHg (range 6-44) that increased to 21.5 mmHg (range 12-29) (P = 0.481) and 31 mmHg (range 16-77) (P = 0.034) on first and second follow-up, respectively. In malignant group, median post-operative pressures were 20 mmHg (range 14-36) and 21 mmHg (range 18-44) on first and second follow-up, respectively. A definite tone and gripping sensation were felt in all the patients on digital examination. On distal loopogram, performed through the diverting colostomies, barium was retained proximal to the neo-pyloric valve. Both perineal ultrasound and MRI showed viable transposed graft. CT angiography and color doppler studies confirmed vascular flow in the transposed position. Conclusions The human pyloric valve can function as a tonic sphincter when removed from the gastroduodenal continuity. PMID:22837874

Ghoshal, Uday C; Gupta, Vishal; Jauhari, Ramendra; Srivastava, Rajendra N; Misra, Asha; Kumar, Ashok; Kumar, Manoj

2012-01-01

36

Recent results of treatment of infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

During the five year period December 1980 to November 1985, 106 infants with hypertrophic pyloric stenosis were treated. There were no operative deaths, but two late deaths occurred from associated abnormalities. The combination of preoperative rehydration, skilled anaesthesia, and the use of the Fredet-Ramstedt operation (pyloromyotomy) have virtually eliminated mortality from uncomplicated infantile hypertrophic pyloric stenosis. The most common complications

B Zeidan; J Wyatt; A Mackersie; R J Brereton

1988-01-01

37

Muscle Thickness in Hypertrophic Pyloric Stenosis: Sonographic Determination  

Microsoft Academic Search

Abdominal sonography was performed in 169 infants with vomiting. The hypertro- phied circular muscle of the pylorus and distal antrum could be seen as a thick, hypoechoic cylinder in all cases of hypertrophic pyloric stenosis. The thickness of each wall of this cylinder was 4 mm or more in 86 of 93 patients subsequently shown to have hypertrophic pyloric stenosis

Joel D. Blumhagen; H. George; S. Noble

38

Ultrasound compared with clinical examination in infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

OBJECTIVES: To assess the accuracy of clinical examination as compared with ultrasound imaging in the diagnosis of infantile hypertrophic pyloric stenosis. Duration of hospital stay, time between admission and surgery, and financial implications were also considered. DESIGN: A prospective study of patients referred to the surgical team with a possible diagnosis of pyloric stenosis from May 1993 to January 1995.

P Godbole; A Sprigg; J A Dickson; P C Lin

1996-01-01

39

Infantile hypertrophic pyloric stenosis in Belfast, 1957-1969  

Microsoft Academic Search

Infants with hypertrophic pyloric stenosis born in Belfast during the 13 years 1957-1969 have been reviewed. Their distribution shows a bias towards higher social classes, breast feeding, and primogeniture. Obstetric factors and parental ages seem to be of no importance. More affected infants were born during winter months than would be expected. The overall incidence of infantile pyloric stenosis in

J A Dodge

1975-01-01

40

Factors associated with infantile hypertrophic pyloric stenosis.  

PubMed

We examined perinatal factors in relation to the rise in incidence of infantile hypertrophic pyloric stenosis among children in Olmsted County, Minnesota, during the period from 1950 through 1984. Primogeniture was associated with male infants but not female infants; some factor related to primogeniture, such as breast-feeding, may be etiologically important. Our data did not support a role for maternal disease, use of doxylamine succinate-pyridoxide hydrochloride (Bendectin), or an infectious process. Further study should be directed toward environmental factors associated with primogeniture. PMID:3344722

Jedd, M B; Melton, L J; Griffin, M R; Kaufman, B; Hoffman, A D; Broughton, D; O'Brien, P C

1988-03-01

41

Advances in infantile hypertrophic pyloric stenosis.  

PubMed

Infantile hypertrophic pyloric stenosis (IHPS) is a common condition in infancy, characterized by an acquired narrowing of the pylorus, which requires surgery. These infants usually present with projectile, nonbilious vomiting, with a palpable 'olive' in the abdomen and sometimes a 'peristaltic wave' after being fed with formula or breast milk. Although IHPS is a common disorder, its etiology is largely unknown. Surgical intervention is the standard treatment, preoperative preparation, however is essential to optimal outcome. In this review, the latest advances in IHPS regarding epidemiology, etiology, diagnostics and treatment will be discussed. PMID:24716658

Peters, Babette; Oomen, Mathijs W N; Bakx, Roel; Benninga, Marc A

2014-07-01

42

Vagal afferent innervation of the lower esophageal sphincter.  

PubMed

To supply a fuller morphological characterization of the vagal afferents innervating the lower esophageal sphincter (LES), specifically to label vagal terminals in the tissues forming the LES in the gastroesophageal junction, the present experiment employed injections of dextran biotin into the nodose ganglia of rats. Four types of vagal afferents innervated the LES. Clasp and sling muscle fibers were directly and prominently innervated by intramuscular arrays (IMAs). Individual IMA terminals subtended about 16° of arc of the esophageal circumference, and, collectively, the terminal fields were distributed within the muscle ring to establish a 360° annulus of mechanoreceptors in the sphincter wall. 3D morphometry of the terminals established that, compared to sling muscle IMAs, clasp muscle IMAs had more extensive arbors and larger receptive fields. In addition, at the cardia, local myenteric ganglia between smooth muscle sheets and striated muscle bundles were innervated by intraganglionic laminar endings (IGLEs), in a pattern similar to the innervation of the myenteric plexus throughout the stomach and esophagus. Finally, as previously described, the principle bundle of sling muscle fibers that links LES sphincter tissue to the antropyloric region of the lesser curvature was innervated by exceptionally long IMAs as well as by unique web ending specializations at the distal attachment of the bundle. Overall, the specialized varieties of densely distributed vagal afferents innervating the LES underscore the conclusion that these sensory projections are critically involved in generating LES reflexes and may be promising targets for managing esophageal dysfunctions. PMID:23583280

Powley, Terry L; Baronowsky, Elizabeth A; Gilbert, Jared M; Hudson, Cherie N; Martin, Felecia N; Mason, Jacqueline K; McAdams, Jennifer L; Phillips, Robert J

2013-10-01

43

[Physiology of the upper esophageal sphincter].  

PubMed

The upper esophageal sphincter (UES) forms a barrier between the pharynx and the esophagus. When opened, the UES allows the food bolus to pass into the esophagus, as well as permitting emesis and eructation. The basal sphincter tone constitutes a barrier function which serves to prevent reflux and passive aerophagia in the case of deep breathing. Basal sphincter tone is dependent on several influencing factors; during swallowing, sphincter opening and closure follow a complex multiphase pattern. This article presents an overview of the current understanding of UES physiology. PMID:24916353

Jungheim, M; Miller, S; Kühn, D; Schwemmle, C; Schneider, J P; Ochs, M; Ptok, M

2014-06-01

44

Infantile hypertrophic pyloric stenosis: Does size really matter?  

PubMed

Pyloric stenosis is a common infantile disorder typically occurring between 2?weeks and 8?weeks of age. Presentation outside this range and in premature infants is uncommon and often atypical. We present three cases, a pair of premature twins and a 5.5-month-old infant with pyloric stenosis. We highlight that despite their difference in size and weight, ultrasound examination remains a reliable diagnostic tool. However, pyloric measurements should be interpreted in combination with the other dynamic features on ultrasound. PMID:20598068

Hsu, Peter; Klimek, Jan; Nanan, Ralph

2014-10-01

45

Voluntary relaxation of the external anal sphincter.  

PubMed

In this study five volunteers with special training in anal sphincter exercise (Scandinavian Yoga School) managed voluntarily to reduce anal pressure. The mean reduction of anal pressure was 20 mm Hg. In one of the subjects, this was shown by manometry during low spinal anesthesia and electromyography to be caused by relaxation of the external anal sphincter. PMID:2714127

Brodén, G; Dolk, A; Frostell, C; Nilsson, B; Holmström, B

1989-05-01

46

External Urethral Sphincter Pressure Measurement: An Accurate Method for the Diagnosis of Detrusor External Sphincter Dyssynergia?  

PubMed Central

Background Combined pelvic floor electromyography (EMG) and videocystourethrography (VCUG) during urodynamic investigation are the most acceptable and widely agreed methods for diagnosing detrusor external sphincter dyssynergia (DESD). Theoretically, external urethral sphincter pressure (EUSP) measurement would provide enough information for the diagnosis of DESD and could simplify the urodynamic investigation replacing combined pelvic floor EMG and VCUG. Thus, we evaluated the diagnostic accuracy of EUSP measurement for DESD. Patients & Methods A consecutive series of 72 patients (36 women, 36 men) with neurogenic lower urinary tract dysfunction able to void spontaneously was prospectively evaluated at a single university spinal cord injury center. Diagnosis of DESD using EUSP measurement (index test) versus combined pelvic floor EMG and VCUG (reference standard) was assessed according to the recommendations of the Standards for Reporting of Diagnostic Accuracy Initiative. Results Using EUSP measurement (index test) and combined pelvic floor EMG and VCUR (reference standard), DESD was diagnosed in 10 (14%) and in 41 (57%) patients, respectively. More than half of the patients presented discordant diagnosis between the index test and the reference standard. Among 41 patients with DESD diagnosed by combined pelvic floor EMG and VCUR, EUSP measurement identified only 6 patients. EUSP measurement had a sensitivity of 15% (95% CI 5%–25%), specificity of 87% (95% CI 76%–98%), positive predictive value of 60% (95% CI 30%–90%), and negative predictive value of 56% (95% CI 44%–68%) for the diagnosis of DESD. Conclusions For diagnosis of DESD, EUSP measurement is inaccurate and cannot replace combined pelvic floor EMG and VCUR. PMID:22701539

Gregorini, Flavia; Birnbock, Dorothee; Kozomara, Marko; Mehnert, Ulrich; Kessler, Thomas M.

2012-01-01

47

The improved ultrasound diagnosis of hypertrophic pyloric stenosis  

Microsoft Academic Search

A prospective study of ultrasound in the diagnosis of idiopathic hypertrophic pyloric stenosis (IHPS) in 200 consecutive infants\\u000a with persistent vomiting is reported. The criteria evaluated include measurements of the pyloric diameter, muscle thickness\\u000a and canal length, and observing the function of the pylorus and gastric peristalsis in real-time. Using these ultrasonic criteria,\\u000a the infants studied were assessed as 112

R. J. Stunden; G. W. LeQuesne; K. E. T. Little

1986-01-01

48

Prenatal prescription of macrolide antibiotics and infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

Objective:To assess the association between prenatal antibiotics, including erythromycin, and infantile hypertrophic pyloric stenosis in a large cohort of infants.Methods:This was a retrospective cohort study of births to women enrolled in Tennessee Medicaid\\/TennCare, 1985–1997. Prescriptions for erythromycin, nonerythromycin macrolides, and other antibiotics were identified from pharmacy files linked with birth certificate files. The primary study outcome was development of pyloric

William O Cooper; Wayne A Ray; Marie R Griffin

2002-01-01

49

[Reconstruction of anal sphincters following fecal incontinence and assessment of functional results].  

PubMed

The aim of the study was to assess functional results of surgical sphincter reconstructions for anal incontinence. From August 1999 to January 2007, 52 patients (females 50, males 2), 45 y.o.a. on average (24-69), underwent secondary anal sphincters reconstructions for fecal incontinence, resulting from birth injuries, event. in combination with sphincter weakening in pudendal neurophathy, or for post-anorectal surgery incontinence. Duration of the incontinence symptoms prior to the surgery was 2 months to 19 years. The overlap technique in combination with anterior levatorplasty was used in most subjects (n = 31). In 12 subjects, anterior sphincters and levators plication was performed. Four patients underwent overlap reconstructions only and five patients underwent complete sphincter reconstructions. Protective colostomy was performed in six patients. Six patients underwent additional postoperative biofeedback. Endoanal ultrasound was performed in all patients prior to their procedures. Terminal motor latency examination of the pudendal nerve was indicated in all patients with sphincter dysfunction without localized defects. Anal manometry was recorded prior and post-operatively. Incontinence was assessed using the St. Mark's incontinence score (0-13). The patients assessed the reconstruction results based on the Likert scale. The reconstruction was successfull in 46 patients (88.5 %), full continence was recovered in 20 (38.5 %) patients and improvement of incontinence was recorded in 26 (50 %) subjects. In six subjects (11.5 %), the reconstruction failed. The mean incontinence score reduction following the procedure was from 11.8 to 2.4. The short-term sphincter reconstruction results were successful in the majority of the subjects, the long-term results will be assessed in another study. PMID:18988486

Slauf, P; Bartoska, P; Ryska, O; Antos, F

2008-08-01

50

Endosonography of the Anal Sphincter: Findings in Healthy Volunteers  

Microsoft Academic Search

Knowledge of the normal sonographic features of the anal canal is essential for the detection of anal carcinomas, anal sphincteric defects, or other anal abnormalities with endosonography. The anal sphincters consist of the circular smooth muscle fibers of the internal sphincter and the circular striated muscle fibers of the external sphincter together with the sling-shaped puborectalis muscle. Anal endosonography was

Michael Bachmann Nielsen; Jan Fog Pedersen; Christina Hauge; John Christiansen

51

Surgical Reconstruction of the Urinary Sphincter after Traumatic Longitudinal Disruption  

PubMed Central

The question is whether the urethral sphincter may be reconstructed after longitudinal injury similar to anal sphincter injuries. Analogue to obstetric, anal sphincter repair, an approximation repair of the sphincter may be feasible. An overlap repair is possible in anal sphincter repair, but because of the little tissue available in the urethral sphincter this is not an option. We describe three cases of urethral sphincter injury of different aetiologies. All resulted in a total longitudinal disruption of the muscular components of the urethral sphincter complex. After making the diagnosis of urethral sphincter injury, a primary approximation repair was done. Follow-up of at least two and up to three years is promising with one male patient being completely continent and the two female patients needing one safety pad per day. Longitudinal disruption of the muscular elements of the sphincteric urethra may be primarily reconstructed with good success using an approximation technique with simple interrupted sutures. PMID:25258694

Rehder, Peter; Schillfahrt, Florian; Skradski, Viktor

2014-01-01

52

Coordinated gastric and sphincter motility evoked by intravenous CCK-8 as monitored by ultrasonomicrometry in rats.  

PubMed

Gastric and sphincter motility evoked by intravenous injection of CCK-8 were investigated in urethane-anesthetized rats. Digital ultrasonomicrometry was used to monitor pyloric (PYL), antral (ANT), corpus (COR), and lower esophageal sphincter (LES) movements while simultaneously measuring intragastric pressure (IGP) and, in some experiments, subdiaphragmatic intraesophageal pressure (sIEP). Intracrystal distances (ICD) were measured continuously between pairs of piezoelectric crystals affixed to the serosa of PYL, ANT, COR (circular and longitudinal), and LES. Consecutive intravenous injections of CCK-8 (0.3, 1, and 3 microg/kg) at 30-min intervals caused dose-dependent simultaneous tonic contractions of PYL and ANT, LES opening, and drops in IGP with peak changes at 3 microg/kg of -17.9 +/- 2.1, -7.7 +/- 2.5, 6.5 +/- 1.4, and -29.2 +/- 3.8%, respectively, whereas intravenous saline had no effect. Rhythmic contractile activity was inhibited by CCK-8. COR responses were not significantly different from vehicle controls for most metrics, and the direction of response for circular COR varied between preparations, although not for repeated trials in a single preparation. During the LES response to CCK-8, sIEP rose in parallel with drops in IGP, indicating formation of a common cavity. Recovery of LES ICD after intravenous CCK occurred more rapidly than recovery of PYL ICD, suggesting the importance of preventing simultaneous patency of gastroesophageal and gastroduodenal passages. The CCK(A) receptor antagonist devazepide (500 microg/kg intravenous) inhibited motion responses evoked by intravenous CCK-8. These data revealed CCK-8-induced gastric and sphincter activity consistent with retropulsion of gastric content. PMID:14715522

Adelson, David W; Million, Mulugeta; Kanamoto, Koki; Palanca, Tiffany; Taché, Yvette

2004-02-01

53

High revision rate following artificial urethral sphincter implantation.  

PubMed

Abstract Objective. In severe cases of stress urinary incontinence (SUI), with sphincter dysfunction, the artificial urinary sphincter AMS 800™ may be the last solution. The purpose of this study was to evaluate the outcome of surgical intervention for SUI with the AMS 800 in patients who were treated at Sahlgrenska University Hospital, Gothenburg. The primary aim of the study was to determine the complications related to the operation. Material and methods. A retrospective follow-up was done by reviewing medical records. The material comprised 97 men, who underwent their first AMS 800 implantation between May 1997 and June 2010 at Sahlgrenska University Hospital. Results. The revision rate was 28%, including an infection rate of 3% and an erosion rate of 7%. The mean follow-up for revised patients was 3 years. The median time until revision was 1 year. Seventy-five per cent of all patients were satisfied with the operation at 6 months' follow-up. Radical prostatectomy was the reason behind incontinence in 84% of patients in this series. Conclusion. The results clearly demonstrate a need for revision procedures in a considerable proportion of patients implanted with an AMS 800 device. Patient satisfaction was high, but although this operation has extremely low mortality it has its complications and the system will need to be replaced in time. PMID:24930564

Andreasson, Anders; Fall, Magnus; Persson, Erik; Stranne, Johan; Peeker, Ralph

2014-12-01

54

Infantile hypertrophic pyloric stenosis and asymptomatic joint hypermobility  

Microsoft Academic Search

A significant association with asymptomatic joint hypermobility was observed in 37 children with a history of infantile hypertrophic pyloric stenosis (P = .0016) and their parents (mothers, P < .0001; fathers, P < .05). The subjects with articular hypermobility showed an increased frequency of absent mandibular frenulum, thereby suggesting the presence of a previously unrecognized, systemic abnormality of the extracellular

Claudio De Felice; Giovanni Di Maggio; Paolo Toti; Stefano Parrini; Angelo Salzano; Urania E. Lagrasta; Franco Bagnoli

2001-01-01

55

Vomiting after pyloromyotomy for infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

An analysis of the factors which may predispose towards postoperative vomiting after pyloromyotomy for hypertrophic pyloric stenosis was carried out in 72 infants at this hospital. 26 (36%) infants experienced moderate to severe postoperative vomiting of sufficient intensity to cause the postoperative feeding regimen to be modified or interrupted. Only two parameters were found to be of statistical significance. These

L Spitz

1979-01-01

56

Congenital pyloric stenosis: a modified umbilical incision for pyloromyotomy  

Microsoft Academic Search

Thirty-two patients underwent a pyloromyotomy via an umbilical incision; in 11 a modified umbilical approach was used to facilitate delivery of the pyloric mass. Incisions are made in the skin fold of the upper half of the umbilicus and at the midline, joining the two at the top. The skin incision is closed by upper umbilical translocation with a very

R. Besson; R. Weir; C. Salakos; P. Debeugny

1997-01-01

57

Genetic analyses of pyloric stenosis suggesting a specific maternal effect  

Microsoft Academic Search

Data on pyloric stenosis are analysed by multiple threshold methods that incorporate the sex effect. The polygenic model of inheritance is rejected; the single major locus model can only account for 37% of the cases having a genetic aetiology, requiring an environmental effect to account for the remainder of the cases. A maternal-fetal interaction for gastrin production and sensitivity is

K K Kidd; M A Spence

1976-01-01

58

The pathology of infantile hypertrophic pyloric stenosis after healing  

Microsoft Academic Search

Introduction: Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical affection of unknown etiology. The muscular hypertrophy is known to resolve within a few months after pyloromyotomy (PM). The pathology of IHPS has been studied extensively at the time of PM, but the fate of the pylorus after healing remains unknown. Materials and Methods: We had the rare opportunity to

Jean-Marie Vanderwinden; Hao Liu; Roberte Menu; Jean-Louis Conreur; Marc-Henri De Laet; Jean-Jacques Vanderhaeghen

1996-01-01

59

Myenteric plexus neuropathy in infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

The myenteric plexus and intramuscular nerve bundles in the circular muscle layer of the pylorus from 37 children with infantile hypertrophic pyloric stenosis (IHPS) obtained at pyloromyotomy were studied by light and electron microscopy and compared to six control cases without clinical evidence of IHPS. In certain IHPS cases degenerative alterations of the axons predominated. The axonal changes consisted of

R. Dieler; J. M. Schröder

1989-01-01

60

Pyloromyotomy versus atropine sulfate for infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

Purpose: Atropine sulfate (atropine) and pyloromyotomy were compared for managing infantile hypertrophic pyloric stenosis (IHPS).Methods: From 1996 to 1998, cases of IHPS treated surgically (pyloromyotomy; n = 20) or medically (atropine; n = 14) at separate institutions were compared retrospectively with regard to status on presentation, physical symptoms and signs, progress, and costs. Atropine was given orally, then intravenously if

Atsuyuki Yamataka; Kazuko Tsukada; Yuko Yokoyama-Laws; Mitsunori Murata; Makiko Osawa; Takao Fujimoto; Takeshi Miyano

2000-01-01

61

Pyloric stenosis in the Oxford Record Linkage Study area  

Microsoft Academic Search

The files of the Oxford Record Linkage Study were employed to identify 220 infants presenting with infantile hypertrophic pyloric stenosis (IHPS) in the 6-year period 1966 to 1971. Information on these infants was obtained from birth certificates and maternity notes. The overall incidence was 2.5 per 1000 livebirths. There was a distinct seasonal variation, with highest incidence to infants born

P Adelstein; J Fedrick

1976-01-01

62

[Surgical tactics in acute inter-sphincter paraproctitis].  

PubMed

The peculiarities of the clinical course, diagnosis and operative treatment of acute inter-sphincter paraproctitis were analysed. The expediency of singling out inter-sphincter paraproctitis into an independent form of the disease is substantiated. PMID:2724797

Timerbulatov, V M

1989-01-01

63

LIM homeodomain transcription factor Isl1 directs normal pyloric development by targeting Gata3  

PubMed Central

Background Abnormalities in pyloric development or in contractile function of the pylorus cause reflux of duodenal contents into the stomach and increase the risk of gastric metaplasia and cancer. Abnormalities of the pyloric region are also linked to congenital defects such as the relatively common neonatal hypertrophic pyloric stenosis, and primary duodenogastric reflux. Therefore, understanding pyloric development is of great clinical relevance. Here, we investigated the role of the LIM homeodomain transcription factor Isl1 in pyloric development. Results Examination of Isl1 expression in developing mouse stomach by immunohistochemistry, whole mount in situ hybridization and real-time quantitative PCR demonstrated that Isl1 is highly expressed in developing mouse stomach, principally in the smooth muscle layer of the pylorus. Isl1 expression was also examined by immunofluorescence in human hypertrophic pyloric stenosis where the majority of smooth muscle cells were found to express Isl1. Isl1 function in embryonic stomach development was investigated utilizing a tamoxifen-inducible Isl1 knockout mouse model. Isl1 deficiency led to nearly complete absence of the pyloric outer longitudinal muscle layer at embryonic day 18.5, which is consistent with Gata3 null mouse phenotype. Chromatin immunoprecipitation, luciferase assays, and electrophoretic mobility shift assays revealed that Isl1 ensures normal pyloric development by directly targeting Gata3. Conclusions This study demonstrates that the Isl1-Gata3 transcription regulatory axis is essential for normal pyloric development. These findings are highly clinically relevant and may help to better understand pathways leading to pyloric disease. PMID:24674670

2014-01-01

64

Clinical and Functional Anatomy of the Urethral Sphincter  

PubMed Central

Continence and micturition involve urethral closure. Especially, insufficient strength of the pelvic floor muscles including the urethral sphincter muscles causes urinary incontinence (UI). Thus, it is most important to understand the main mechanism causing UI and the relationship of UI with the urethral sphincter. Functionally and anatomically, the urethral sphincter is made up of the internal and the external sphincter. We highlight the basic and clinical anatomy of the internal and the external sphincter and their clinical meaning. Understanding these relationships may provide a novel view in identifying the main mechanism causing UI and surgical techniques for UI. PMID:23094214

Ahn, Hyo Kwang; Huh, Youngbuhm

2012-01-01

65

Pyloric trichobezoar in a Canadian lynx (Lynx canadensis).  

PubMed

An adult female Canadian lynx (Lynx canadensis) was presented with a 3-wk history of anorexia and lethargy. Initial examination and diagnostics did not provide a diagnosis. The lynx continued to demonstrate vague clinical signs, including anorexia and an abnormal gait. During follow-up immobilizations 2 wk later, a barium gastrointestinal study revealed a pyloric obstruction. Abdominal exploratory surgery was elected, and a gastrotomy and an enterotomy of the proximal duodenum were performed to remove the pyloric obstruction. The obstruction was determined to be a trichobezoar. Fleas, a likely cause of hair ingestion through grooming, were noted during surgical preparation. The lynx made a full recovery from surgery. Reoccurrence of the trichobezoar was prevented after surgery with the use of monthly flea control and three times a week hairball laxative. PMID:24450081

Kottwitz, Jack; Munsterman, Amelia S

2013-12-01

66

Early experience with laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

The authors report on 37 infants with infantile hypertrophic pyloric stenosis who underwent successful laparoscopic pyloromyotomy. The average age was 6 weeks and average weight was 4.5 kg. Three 4-mm ports were used in each procedure. The average operating time was 29 minutes (range, 7 to 60 minutes). Feeding was begun an average of 5.2 hours (range, 3 to 12

A Najmaldin; H. L Tan

1995-01-01

67

Pathogenesis of infantile hypertrophic pyloric stenosis: recent progress  

Microsoft Academic Search

Although infantile hypertrophic pyloric stenosis (IHPS) is the most common condition requiring surgery in the first few months\\u000a of life, its pathogenesis is not fully understood. Reviews of the recent progress in the pathogenesis of IHPS show: (1) there\\u000a is increasing evidence to suggest that smooth-muscle cells in IHPS are not properly innervated; (2) because non-adrenergic,\\u000a non-cholinergic nerves are mediators

K. Ohshiro; P. Puri

1998-01-01

68

The feasibility and reliability of using circular electrode for sphincter of Oddi electromyography in anaesthetised rabbits.  

PubMed

Sphincter of Oddi manometry (SOM) is the gold standard for assessing sphincter of Oddi dysfunction (SOD), but is considered a diagnostic sensitivity of 30-80% and associated with significant complications of pancreatitis. Electromyography (EMG) of sphincter of Oddi (SO) using a circular electrode (CE) may be useful in improving diagnostic accuracy and reducing complications. To evaluate the feasibility and reliability of the CE, we record myoelectric activity of SO in rabbits using the CE to compare with the traditional needle electrode (NE). The CE was prepared using a double-channel biogel catheter with two silver rings at the head of the catheter. The CE was then inserted into the lumen of the SO through the duodenal papilla, and myoelectric activity was recorded in the SO in 30 rabbits. An EMG recorded using an NE was performed at the same time, when the SO was in basal state, after injection of cholecystokinin and N-butylscopolamine bromide. Electromyographs recorded by the two methods were then evaluated. Satisfactory SO EMGs were acquired using the CE without any injury. Simultaneous recording revealed a very similar traces and one-to-one correspondence of SO spike bursts (SOSB). Linear regression analysis showed a significant direct correlation between the two methods for SOSB duration and amplitude. The results suggested that CE was comparable with NE in terms of recording efficacy. The CE also has advantages of easy fixation, accurate localisation, broad applicability and ease of achieving satisfactory outcomes without trauma, compared with the NE. PMID:19210627

Chen, F; Chen, J; Dong, J-H; Chen, M; Li, H-C; Li, X-W; Li, Z-H

2009-06-01

69

Who should treat pyloric stenosis: The general or specialist pediatric surgeon?  

Microsoft Academic Search

Recent reports suggest that children under 3 years of age are best operated on by a specialist pediatric surgeon. In the United Kingdom, hypertrophic pyloric stenosis traditionally has been treated by adult general surgeons. Should this change? In 1991, a retrospective review of 10 years' experience with pyloric stenosis, managed by general surgeons in a large district general hospital, was

A. J. L Brain; D. S Roberts

1996-01-01

70

Altered messenger RNA expression of the neuronal nitric oxide synthase gene in infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

Nitric oxide (NO) has been described as a mediator of smooth muscle relaxation in the mammalian gastrointestinal tract. The enzyme neuronal nitric oxide synthase (NOS) catalyzes the formation of NO. We examined the expression of the neuronal NOS gene at the messenger RNA (mRNA) level in pyloric smooth-muscle biopsy specimens from six patients with infantile hypertrophic pyloric stenosis (IHPS) using

T. Kusafuka; P. Puri

1997-01-01

71

A rare association of pyloric stenosis and situs inversus: impact on diagnosis and treatment.  

PubMed

A rare case of 23 days old boy is reported having congenital hypertrophic pyloric stenosis with situs inversus. Incidentally detected secondary diagnosis obscured the primary diagnosis by altering the physical examination findings. Diagnosis was made by ultrasonography (USG) which revealed congenital hypertrophic pyloric stenosis with situs inversus. Clinical details, diagnosis and management are discussed. PMID:24741544

Gupta, Anil Kumar; Yadav, Lokesh; Pathak, Manish

2014-01-01

72

Hypertrophic pyloric stenosis in infants: is it a congenital or acquired disorder? Reflections on 2 cases.  

PubMed

Based on evidence from two collected and treated clinical observations of hypertrophic pyloric stenosis in children of 5 and 12 months of age, the authors give their point of view on the unresolved issue of the etiology of hypertrophic pyloric stenosis. They emphasize that there are more and more factors to prove this is an acquired condition. PMID:25332858

Mouafo Tambo, Faustin Félicien; Kouna Tsala, Irène Nadine; Ngowe Ngowe, Marcelin; Andze Ondobo, Gervais; Sosso, Maurice Aurelien

2014-01-01

73

Transient hypertrophic pyloric stenosis due to prostoglandin infusion.  

PubMed

Prostaglandin E1 (PGE1) is widely used in ductus-dependant congenital heart disease to maintain the patency of ductus. Hypertrophic pyloric stenosis (HPS) due to gastric mucosal proliferation is a rare complication of prolonged PGE infusion. A male newborn who developed HPS during PGE1 infusion is presented to discuss the clinical features and treatment modalities of PGE-related transient HPS. The boy was 2500?g and born at 35 weeks of gestation from a 23-year-old mother. He was admitted to neonatal intensive care with breathing difficulty and cyanosis. His echocardiography revealed pulmonary atresia, ventricular septal defect and major aorta-pulmonary collateral (MAPCA). PGE infusion with a dose of 0.05?mcg?kg(-1) was initiated. At the 8th day of infusion, he developed non-billous vomiting. Ultrasonographic evaluation revealed 1.9?cm length of pyloric channel and 0.5?cm of wall thickness on 11th day and diagnosed as HPS. On 42th postnatal day, he underwent MAPCA closure, right modified Blalock-Taussi shunt and repair of pulmonary artery bifurcation with bovine patch. PGE infusion was stopped and enteral nutrition was started on 8th postoperative day. Control ultrasonography on 12th postoperative day revealed normal pyloric channel length (0.9?cm) and wall thickness (0.3?cm). Prolonged use of PGE infusion in neonates with congenital heart disease may cause transient HPS. The clinical and radiological features of HPS relieves after stopping PGE infusion. It should be kept in mind that HPS due to PGE infusion can be transient and pyloromyotomy should be kept for patients with persistent findings. PMID:25263728

Soyer, T; Yalcin, S; Bozkaya, D; Yi?it, S; Tanyel, F C

2014-10-01

74

[Disorders of the bladder sphincter. Etiopathogenic approach].  

PubMed

Disorders of the vesico-sphincteral system are due to multiple causes (urological, gynaecological, neurological, psycho-behavioural, iatrogenic) which may be associated. By providing information on the type and evolution of these disorders and on the circumstances in which they developed, questioning is fundamental for the diagnosis. Completed by physical examination, it must precede all exploratory methods, including urodynamic, electrophysiological and radiological examinations. It allows these examinations to be graded and, compared with the results, it gives a better understanding of the physiopathology and aetiology of micturition disorders and therefore ensures their better treatment. PMID:8265530

Amarenco, G; Kerdraon, J; Denys, P

1993-10-16

75

Anal Sphincter Injury After Forceps Delivery: Myth or Reality?  

Microsoft Academic Search

PURPOSE: This study was designed to estimate the prevalence of anal sphincter injury after forceps delivery in a large population of females managed by trained obstetricians in a French hospital and to identify factors predictive for anal sphincter injury. METHODS: We performed a prospective study of healthy females older than 18 years with no history of anal incontinence, anorectal abnormalities,

V. de Parades; I. Etienney; D. Thabut; S. Beaulieu; M. Tawk; B. Assemekang; M. L. Toubia; V. Marié; A. Wehbe; H. Mosnier; P. Gadonneix; T. Harvey; P. Atienza

2004-01-01

76

Infantile hypertrophic pyloric stenosis in Belfast, 1957-1969.  

PubMed Central

Infants with hypertrophic pyloric stenosis born in Belfast during the 13 years 1957-1969 have been reviewed. Their distribution shows a bias towards higher social classes, breast feeding, and primogeniture. Obstetric factors and parental ages seem to be of no importance. More affected infants were born during winter months than would be expected. The overall incidence of infantile pyloric stenosis in this community has fallen during the period under review. Clinically, the patients started vomiting at a mean age of 22 days and it is recommended that the condition should not be called 'congenital'. The size of the tumour is mainly determined by the size of the patient, rather than by his age or duration of symptoms. Attention is drawn to the occurrence of haematemesis in 17-5% and melaena in 2-9% of infants. Jaundice occurred in 1-8% of patients in this series, and is attributed to the adverse effect of starvation on hepatic glucuronyl transferase activity. Other conditions noted in these patients included inguinal hernia, partial thoracic stomach, and phenylketonuria. Subsequent growth and development were in the anticipated range. PMID:1170811

Dodge, J A

1975-01-01

77

Infantile hypertrophic pyloric stenosis in Belfast, 1957-1969.  

PubMed

Infants with hypertrophic pyloric stenosis born in Belfast during the 13 years 1957-1969 have been reviewed. Their distribution shows a bias towards higher social classes, breast feeding, and primogeniture. Obstetric factors and parental ages seem to be of no importance. More affected infants were born during winter months than would be expected. The overall incidence of infantile pyloric stenosis in this community has fallen during the period under review. Clinically, the patients started vomiting at a mean age of 22 days and it is recommended that the condition should not be called 'congenital'. The size of the tumour is mainly determined by the size of the patient, rather than by his age or duration of symptoms. Attention is drawn to the occurrence of haematemesis in 17-5% and melaena in 2-9% of infants. Jaundice occurred in 1-8% of patients in this series, and is attributed to the adverse effect of starvation on hepatic glucuronyl transferase activity. Other conditions noted in these patients included inguinal hernia, partial thoracic stomach, and phenylketonuria. Subsequent growth and development were in the anticipated range. PMID:1170811

Dodge, J A

1975-03-01

78

Urinary Dysfunction  

MedlinePLUS

... PCF Spotlight Glossary African American Men Living with Prostate Cancer Urinary Dysfunction Side Effects Urinary Dysfunction Bowel Dysfunction ... dysfunction is normal following initial therapy for localized prostate cancer. But it’s important to realize that not all ...

79

Optimization of the artificial urinary sphincter: modelling and experimental validation  

NASA Astrophysics Data System (ADS)

The artificial urinary sphincter should be long enough to prevent strangulation effects of the urethral tissue and short enough to avoid the improper dissection of the surrounding tissue. To optimize the sphincter length, the empirical three-parameter urethra compression model is proposed based on the mechanical properties of the urethra: wall pressure, tissue response rim force and sphincter periphery length. In vitro studies using explanted animal or human urethras and different artificial sphincters demonstrate its applicability. The pressure of the sphincter to close the urethra is shown to be a linear function of the bladder pressure. The force to close the urethra depends on the sphincter length linearly. Human urethras display the same dependences as the urethras of pig, dog, sheep and calf. Quantitatively, however, sow urethras resemble best the human ones. For the human urethras, the mean wall pressure corresponds to (-12.6 ± 0.9) cmH2O and (-8.7 ± 1.1) cmH2O, the rim length to (3.0 ± 0.3) mm and (5.1 ± 0.3) mm and the rim force to (60 ± 20) mN and (100 ± 20) mN for urethra opening and closing, respectively. Assuming an intravesical pressure of 40 cmH2O, and an external pressure on the urethra of 60 cmH2O, the model leads to the optimized sphincter length of (17.3 ± 3.8) mm.

Marti, Florian; Leippold, Thomas; John, Hubert; Blunschi, Nadine; Müller, Bert

2006-03-01

80

Analog electronic model of the lobster pyloric central pattern generator  

NASA Astrophysics Data System (ADS)

An electronic circuit intended to simulate the nonlinear dynamics of a simplified 3-cell model of the pyloric central pattern generator in California spiny lobster stomato gastric ganglion is presented. The model employs the synaptic phase locked loop (SPLL) concept where the frequency of oscillations of a postsynaptic cell is mainly controlled by the synaptic current which depends on the phase shift between the oscillations. The theoretical study showed that the system has a stable steady state with correct phase shifts between the oscillations and that this regime is stable when the frequency of the pacemaker cell is varied over a wide range. The main bifurcations in the system were studied analytically, in computer simulations, and in experiments with the electronic circuit. The experimental measurements are in good agreement with the expectations of the theoretical model.

Volkovskii, A.; Brugioni, S.; Levi, R.; Rabinovich, M.; Selverston, A.; Abarbane, H. D. I.

2005-01-01

81

[Gastroduodenal stent placement in gastric cancer patients with pyloric stenosis].  

PubMed

We examined 11 gastric cancer patients undergoing gastroduodenal stent placement for the treatment of gastric outlet obstruction at our hospital, and assessed the significance and problems associated with stenting. None of the patients exhibited any complications associated with stenting, and the median post-stenting fasting period was 3 days(range, 1-7 days). Oral intake improved significantly in all the patients; in patients with nasogastric tubes, the tubes were removed after stenting. However, in patients with peritoneal dissemination, oral intake alone was not sufficient, and additional parenteral nutrition was required. In conclusion, gastroduodenal stenting is believed to be useful for palliative care in gastric cancer patients with pyloric stenosis. PMID:24393888

Kawabata, Ryohei; Kimura, Yutaka; Kawase, Tomono; Kitamura, Shinji; Yabuta, Takamasa; Tsukamoto, Yuki; Mitsudo, Daichi; Gohara, Aya; Fukunaga, Mutsumi; Ohzato, Hiroki

2013-11-01

82

[Anal sphincter injury caused by falling off a trampoline].  

PubMed

A girl of preschool age fell off a trampoline in a sitting position onto an iron bar sticking up from the ground. In addition to a laceration of the terminal portion of the rectum, she was found to have a severe sphincter injury. The sphincters were repaired by a surgeon the next morning. After one month from the surgery the anal canal pressure was found to be symmetrical with good contractile force of the sphincters. No abnormalities were found in a contrast study or in rectoscopy. The protective stoma was closed after three months from the injury and fecal continence was normal after one and a half years. PMID:23901741

Pakarinen, Mikko

2013-01-01

83

Sphincter anal artificiel dans l’incontinence anale sévère  

Microsoft Academic Search

\\u000a Résumé  \\u000a Objectif: Evaluer le résultat de l’implantation d’un sphincter anal artificiel pour incontinence fécale sévère chez 56 patients opérés\\u000a dans le même hôpital. L’implantation d’un sphincter anal artificiel est proposé dans le cadre de l’incontinence anale sévère\\u000a lorsque le traitement local n’est pas adapté ou a échoué.\\u000a \\u000a \\u000a Méthodes: Un sphincter anal artificiel a été implanté chez 56 patients de 1993

F. Michot; Anne-Marie Leroi; Ph. Denis

2004-01-01

84

[Therapy of male urinary incontinence: artificial sphincter versus male slings].  

PubMed

Different kinds of sling systems for the therapy of male urinary incontinence have been developed during the last decade. All systems work by compressing the male urethra. There are adjustable and non-adjustable systems. Implantation is mostly a minimally invasive procedure. On the other hand the well-established AMS 800 hydraulic artificial sphincter has been available since 1972. Recently, another hydraulic artificial sphincter (FlowSecure) has become available providing a boost of occlusive pressure during stress. The aim of this review is to compare effectiveness and indications of the different techniques compared to the artificial sphincter. PMID:22399110

Leicht, W; Thüroff, J

2012-03-01

85

Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a prospective, randomized controlled trial  

Microsoft Academic Search

BackgroundSeveral authors have reported on laparoscopic pyloromyotomy (LP) since the technique was originally described in 1990, but its benefits remain unproven. We performed a randomized controlled trial comparing LP to open circumumbilical pyloromyotomy (OP) for hypertrophic pyloric stenosis.

Marc-David Leclair; Valérie Plattner; Eric Mirallie; Corinne Lejus; Jean-Michel Nguyen; Guillaume Podevin; Yves Heloury

2007-01-01

86

Lack of intestinal pacemaker (C-KIT-positive) cells in infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

The pathogenesis of infantile hypertrophic pyloric stenosis (IHPS) is not well understood. Recent studies have shown that the protooncogene c-kit is essential for the development or maintenance of autonomic gut motility, and also show that the c-kit gene protein product (C-KIT) positive cells in the mammalian gut are responsible for intestinal pacemaker activity. This study examines cells in the pyloric

Atsuyuki Yamataka; Toshio Fujiwara; Yoshifumi Kato; Tadaharu Okazaki; Masakatsu Suhagawa; Takeshi Miyano

1996-01-01

87

Characteristics of neurogenic voiding dysfunction in cerebellar stroke: a cross-sectional, retrospective video urodynamic study.  

PubMed

Voiding dysfunctions are common neurological complications after a stroke, yet there are few urodynamic studies of patients with cerebellar stroke. We report the video urodynamic findings of 15 patients with cerebellar stroke, including eight patients with ischemic and seven with hemorrhagic stroke. Their mean age was 75?±?13.4 years and the mean interval from stroke to video urodynamic study was 11.2?±?17.9 months. At urodynamic study, four (50 %) patients with ischemic stroke had urinary incontinence as did two (28 %) patients with hemorrhagic stroke. Detrusor overactivity (DO) was found in eight (53 %) patients, dyssynergic urethral sphincter in six (40 %), and nonrelaxing urethral sphincter in seven (47 %). DO occurred in six (75 %) of patients with ischemic stroke and in two (28.6 %) of patients with hemorrhagic stroke (p?=?0.072). While DO was not found in five of the 15 patients within 2 months after the stroke, it was more frequently detected in eight (80 %) of the 10 remaining patients 2 or more months after stroke (p?=?0.007). Four (80 %) of the five stroke patients had nonrelaxing sphincter and urinary retention within 2 months after stroke. Two or more months after their strokes, coordinated sphincter function was noted in two (20 %) patients and dyssynergic sphincter was found in six (60 %); two (20 %) remained with nonrelaxing sphincter. Thus, lower urinary tract dysfunction caused by cerebellar stroke may change with time. Knowledge of video urodynamic findings should help us better manage voiding dysfunction in patients with cerebellar stroke. PMID:23504292

Chou, Yu-Cheng; Jiang, Yuan-Hong; Harnod, Tomor; Kuo, Hann-Chorng

2013-10-01

88

Single-nucleotide promoter polymorphism alters transcription of neuronal nitric oxide synthase exon 1c in infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

Infantile hypertrophic pyloric stenosis (IHPS), characterized by enlarged pyloric musculature and gastric-outlet obstruction, is associated with altered expression of neuronal nitric oxide synthase (nNOS). Here we have studied molecular mechanisms by which nNOS gene expression is altered in pyloric tissues of 16 infants with IHPS and 9 controls. A significant decreased expression of total nNOS mRNA was found by quantitative

Dieter Saur; Jean-Marie Vanderwinden; Barbara Seidler; Roland M. Schmid; Marc-Henri de Laet; Hans-Dieter Allescher

2004-01-01

89

A Catheter-Based Acoustic Interrogation Device for Monitoring Motility Dynamics of the Lower Esophageal Sphincter  

PubMed Central

This paper presents novel minimally-invasive, catheter-based acoustic interrogation device for monitoring motility dynamics of the lower esophageal sphincter (LES). A micro-oscillator actively emitting sound wave at 16 kHz is located at one side of the LES, and a miniature microphone is located at the other side of the sphincter to capture the sound generated from the oscillator. Thus, the dynamics of the opening and closing of the LES can be quantitatively assessed. In this paper, experiments are conducted utilizing an LES motility dynamics simulator. The sound strength is captured by the microphone and is correlated to the level of LES opening and closing controlled by the simulator. Measurements from the simulator model show statistically significant (p < 0.05) Pearson correlation coefficients (0.905 on the average in quiet environment and 0.736 on the average in noisy environment, D.O.F. = 9). Measuring the level of LES opening and closing has the potential to become a valuable diagnostic technique for understanding LES dysfunction and the disorders associated with it. PMID:25120160

Lu, Qian; Yadid-Pecht, Orly; Sadowski, Daniel C.; Mintchev, Martin P.

2014-01-01

90

Pyloric ceca of fish: a "new" absorptive organ.  

PubMed

The functions of the blind appendages attached to the proximal intestine of many fish, the pyloric ceca, have been disputed. Hence we recorded morphological parameters and nutrient uptake rates in the ceca and intestine of four fish species (rainbow trout, cod, largemouth bass, and striped bass) with various degrees of cecal development (the ceca contribute 70, 69, 42, and 16% of the total postgastric surface area, respectively). Proline and glucose uptake, measured in vitro, is similar in the ceca and proximal intestine. For these two solutes in these four species, and for 10 other solutes (9 amino acids and 1 dipeptide) in trout, the ceca contribute about the same percentage to uptake as to total gut area. Trout ceca and intestine have similar membrane-bound disaccharidase activity. Separate experiments with trout fed either graded glass beads or a radiopaque marker and then X-rayed show that the ceca fill and empty with particles less than 150 microns and over the same time course as the proximal intestine. Thus ceca are an adaptation for increasing intestinal surface area without increasing the length or thickness of the intestine itself. Fish ceca are entirely different from the distally located ceca of birds and mammals, which have fermentation functions. PMID:3812690

Buddington, R K; Diamond, J M

1987-01-01

91

Pyloric stenosis in the Oxford Record Linkage Study area.  

PubMed Central

The files of the Oxford Record Linkage Study were employed to identify 220 infants presenting with infantile hypertrophic pyloric stenosis (IHPS) in the 6-year period 1966 to 1971. Information on these infants was obtained from birth certificates and maternity notes. The overall incidence was 2.5 per 1000 livebirths. There was a distinct seasonal variation, with highest incidence to infants born in the third quarter of the year as well as variation in incidence with area: the cities had much lower rates of IHPS than the adjacent rural or small urban areas. It was shown that the rates in the south and east of the area studied were far greater than in the north and west. In the present study there was no excess of primiparae, the peak maternal age group was 20 to 24; there was a slight excess of parents of social classes I and II; and a significant association with mothers who were Rhesus negative. The rate of IHPS among sibs was 85 per 1000. Though there was the usual correlation with the male sex (M:F ratio = 5.5:1), there was no variation with birthweight and only among the females was an association found with prolonged gestation. There appeared to be an inverse relation between gestation and age on admission to hospital. Images PMID:1018303

Adelstein, P; Fedrick, J

1976-01-01

92

Bladder, Bowel, and Sexual Dysfunction in Parkinson's Disease  

PubMed Central

Bladder dysfunction (urinary urgency/frequency), bowel dysfunction (constipation), and sexual dysfunction (erectile dysfunction) (also called “pelvic organ” dysfunctions) are common nonmotor disorders in Parkinson's disease (PD). In contrast to motor disorders, pelvic organ autonomic dysfunctions are often nonresponsive to levodopa treatment. The brain pathology causing the bladder dysfunction (appearance of overactivity) involves an altered dopamine-basal ganglia circuit, which normally suppresses the micturition reflex. By contrast, peripheral myenteric pathology causing slowed colonic transit (loss of rectal contractions) and central pathology causing weak strain and paradoxical anal sphincter contraction on defecation (PSD, also called as anismus) are responsible for the bowel dysfunction. In addition, hypothalamic dysfunction is mostly responsible for the sexual dysfunction (decrease in libido and erection) in PD, via altered dopamine-oxytocin pathways, which normally promote libido and erection. The pathophysiology of the pelvic organ dysfunction in PD differs from that in multiple system atrophy; therefore, it might aid in differential diagnosis. Anticholinergic agents are used to treat bladder dysfunction in PD, although these drugs should be used with caution particularly in elderly patients who have cognitive decline. Dietary fibers, laxatives, and “prokinetic” drugs such as serotonergic agonists are used to treat bowel dysfunction in PD. Phosphodiesterase inhibitors are used to treat sexual dysfunction in PD. These treatments might be beneficial in maximizing the patients' quality of life. PMID:21918729

Sakakibara, Ryuji; Kishi, Masahiko; Ogawa, Emina; Tateno, Fuyuki; Uchiyama, Tomoyuki; Yamamoto, Tatsuya; Yamanishi, Tomonori

2011-01-01

93

Molecular cytogenetic characterisation of partial trisomy 9q in a case with pyloric stenosis and a review  

Microsoft Academic Search

Partial trisomy 9q represents a rare and heterogeneous group of chromosomal aberrations characterised by various clinical features including pyloric stenosis. Here, we describe the case of a 1 year old female patient with different dysmorphic features including pyloric stenosis and prenatally detected partial trisomy 9q. This partial trisomy 9q has been analysed in detail to determine the size of the

Anita Heller; J Seidel; A Hübler; H Starke; V Beensen; G Senger; M Rocchi; J Wirth; I Chudoba; U Claussen; T Liehr

2000-01-01

94

Comparative morphology of the pyloric armature of adult mosquitoes (Diptera: Culicidae).  

PubMed

The structure of the pyloric armature, hypothesized to aid in blood-meal digestion or parasite resistance, was compared quantitatively among the following 8 species in 5 genera of adult mosquitoes from the southeastern United States: Aedes albopictus, Aedes japonicus, Aedes triseriatus, Anopheles punctipennis, Culex pipiens s.l., Culex restuans, Orthopodomyia signifera, and Toxorhynchites rutilus. Females differed significantly among species in the structure of spines composing the armature, with Aedes spp. forming one general group, Culex spp. another, and An. punctipennis and Or. signifera a third. Relationships of species based on structural characters of the armature were consistent with recent culicid phylogenies. Although pyloric armature has been noted in mosquitoes and other insects, this is the first quantitative investigation of the mosquito pyloric armature. PMID:22548826

Tuten, H C; Bridges, W C; Adler, P H

2012-09-01

95

[Recurrent pyloric stenosis in a 7-year-old child with chronic granulomatous disease].  

PubMed

Hypertrophic pyloric stenosis is a common affection in infants aged 3-8 weeks and typically does not affect older children. We report a case of pyloric stenosis that occurred recurrently at the ages of 3 and 7 years in a boy with X-linked chronic granulomatous disease. We emphasize the inflammatory origin of such stenosis, whose progression was favorable thanks exclusively to drug treatment with corticosteroids. We note that chronic granulomatous disease can affect the entire digestive tract, similar to inflammatory bowel disease in children. PMID:24182666

Perdereau, S; Touzot, F; Robin, L; Hébert, C; Monceaux, F; Dimitrov, G

2013-12-01

96

Question of an infectious etiology or contribution to the pathogenesis of infantile hypertrophic pyloric stenosis.  

PubMed

Infantile hypertrophic pyloric stenosis is a concerning cause of nonbilious vomiting in the neonatal population. Although a number of etiological theories exist, its exact cause remains nebulous. The question of an infectious etiology (or contribution) has been previously examined in case reports and case series, with recent support through suggestions of seasonality and familial aggregation with unclear inheritance patterns. The present review discusses the published literature regarding infectious etiologies of infantile hypertrophic pyloric stenosis. Furthermore, it attempts to demonstrate that newer research regarding an NOS1 genetic etiology does not exclude, but rather can be consistent with, an infectious etiology. PMID:24345839

Modarressi, Taher

2014-05-01

97

Olive without a cause: the story of infantile hypertrophic pyloric stenosis.  

PubMed

For many diseases and medical conditions the clinical recognition and the development of accurate diagnostic methods and the etiological cause precede effective treatment. In the case of infantile hypertrophic pyloric stenosis (HPS), this sequence of events did not happen. Clinical recognition of the entity proceeded directly to the development of curative treatment. Reliable diagnostic imaging methods followed, but a definitive etiology has not been elucidated. This paper reviews the historical aspects of hypertrophic pyloric stenosis, discusses how and why it took so long for this not uncommon disease to be recognized, and highlights the physicians who changed an often fatal disease into an easily diagnosed and treated minor affliction. PMID:24281686

Markowitz, Richard I

2014-02-01

98

Jaundice with hypertrophic pyloric stenosis as an early manifestation of Gilbert syndrome  

PubMed Central

Jaundice associated with hypertrophic pyloric stenosis was recognised in three patients; previous reports have suggested that this is a possible early manifestation of Gilbert syndrome. Most patients with Gilbert syndrome are homozygous for a (TA)7TAA polymorphism in the gene promoter coding for bilirubin glucuronosyltransferase. Two of the reported patients were homozygous for the (TA)7TAA polymorphism whereas the third was heterozygous for the same polymorphism. Furthermore, no other factors contributing to jaundice in the three patients were found. These results suggest that jaundice associated with hypertrophic pyloric stenosis is due to molecular defects within the gene promoter.?? PMID:10490432

Trioche, P.; Chalas, J.; Francoual, J.; Capel, L.; Lindenbaum, A.; Odievre, M.; Labrune, P.

1999-01-01

99

Effect of histamine and substance P on the rabbit and human iris sphincter muscle  

Microsoft Academic Search

• Background and methods: In an attempt to clarify the functional action of histamine and substance P on atropine-resistant miosis, we isolated rabbit and human iris sphincter muscles and investigated their mechanical properties using the isometric tension recording method. • Results: Substance P dose-dependently contracted the rabbit iris sphincter, but had no effect on the human iris sphincter. In the

Takeshi Yoshitomi; Hitoshi Ishikawa; Isao Haruno; Satoshi Ishikawa

1995-01-01

100

Relationship of symptoms in faecal incontinence to specific sphincter abnormalities.  

PubMed

We aimed to determine if the type of clinical presentation in patients with faecal incontinence correlated with the underlying sphincter pathology. One hundred fifty one consecutive patients (129 female) with faecal incontinence were classified as having either passive (faecal incontinence without the patient's knowledge) or urge incontinence (incontinence occurring with the patient's awareness, against their will because of lack of voluntary control), and were investigated by routine anorectal physiological testing and anal endosonography. Sixty six patients had passive incontinence (PI) only, 42 patients had urge incontinence (UI) only, 38 patients had combined passive and urge incontinence, and 5 patients had soiling after defaecation only. Patients with PI alone (n = 66) were significantly older than those with UI alone (PI vs UI, 60 vs 42 yr, p < 0.001), had a lower maximum resting anal pressure (51 vs 64 cm H2O, means, p = 0.02) and had a significantly (p < 0.001) greater prevalence of internal anal sphincter (IAS) defects. Patients with UI alone (n = 42) had a significantly lower maximum voluntary contraction pressure (PI v UI, 72 v 42 cm H2O, p < 0.001), and a significantly (p < 0.001) greater prevalence of external anal sphincter (EAS) defects. The clinical classification of faecal incontinence into passive and urge incontinence relates to specific patterns of abnormality of the internal and external anal sphincters. PMID:7561433

Engel, A F; Kamm, M A; Bartram, C I; Nicholls, R J

1995-01-01

101

Damaging effects of anal stretching on the external anal sphincter  

Microsoft Academic Search

Purpose: This study was undertaken to investigate the effects of anal stretching on anal pressures and damage to the external anal sphincter. METHODS: This study was performed on 37 guinea pigs. Animals were divided into three groups: control group, quick stretching group, and continuous overstretching group. Anal stretching was conducted by an 8-F Foley® catheter balloon. RESULTS: It was found

Long Li; Jin-Zhe Zhang; Guo-Wei Lu; Guo-Rei He; Xiao-Hong Lui

1996-01-01

102

Rectocele and anal sphincter defect - surgical anatomy and combined repair.  

PubMed

This study reports on the surgical anatomy and technique of perineal repair in a selected group of parous women with faecal incontinence and/or difficulty in evacuation. Anal sphincter muscle damage is usually attributed to childbirth, although most of these women present for the first time years later. Consecutive patients with the above symptoms were examined clinically and then investigated with a perineal ultrasound scan. During the perineal operation for repair, further investigation by transillumination and measurements with calipers were done in 50 patients. All patients received routine postoperative care, and were followed up for at least 6 months. From 1995 to 2009 a total of 117 patients, all female, underwent perineal repair by a single surgeon. The age range was 24 - 82 years. In the last 50 consecutive patients, transillumination was positive prior to repair in all, and negative after. The average thickness of the rectocele wall was 2.4 mm prior to repair and 4.8 mm after. In all patients a rectocele was found in conjunction with the anal sphincter defect. The results of combined repair were satisfactory in 109 of 117 patients (93%). A rectocele consists of rectal mucosa, and represents a pulsion diverticulum of the lower anterior rectum. The mucosa herniates through a defect in the midline in the lower anterior rectal muscle wall. This defect then extends into the internal and external anal sphincters. It is a consistent finding in women with faecal incontinence due to anal sphincter disruption. If the anterior rectal muscle wall is repaired first, anal sphincter repair is facilitated. PMID:22353268

Mills, Robert P

2011-11-01

103

Genome-wide linkage analysis in families with infantile hypertrophic pyloric stenosis indicates novel susceptibility loci  

Microsoft Academic Search

Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of upper gastrointestinal obstruction during infancy. A multifactorial background of the disease is well established. Multiple susceptibility loci including the neuronal nitric oxide synthase (NOS1) gene have previously been linked to IHPS, but contradictory results of linkage studies in different materials indicate genetic heterogeneity. To identify IHPS susceptibility loci, we conducted

Anna Svenningsson; Cilla Söderhäll; Sofia Persson; Fredrik Lundberg; Holger Luthman; Eddie Chung; Mark Gardiner; Ingrid Kockum; Agneta Nordenskjöld

2012-01-01

104

Endocrine cells in the antro-pyloric mucosa of the stomach  

Microsoft Academic Search

A type of endocrine-like cell displaying all morphological features of protein secreting cells, has been found in the antro-pyloric mucosa of the stomach of mammals. Light and electron microscopy observations provide a sharp distinction of this cell from the 5-hydroxytryptamine-storing enterochromaffin cell. Its possible involvement in the secretion of a protein or peptide hormone is discussed.

E. Solcia; G. Vassallo; R. Sampietro

1967-01-01

105

Dominantly-inherited polycystic kidneys in infants: Association with hypertrophic pyloric stenosis  

Microsoft Academic Search

Newborn male fraternal twins presented at 10 days of age with bilateral flank masses; intravenous urograms showed polycystic kidney disease. Both babies also had hypertrophic pyloric stenosis (HPS). Their father has radiographic and sonographic findings of previously unsuspected polycystic kidneys and has a history of HPS in infancy. The association of dominantly-inherited polycystic kidneys (DPK) and HPS in this family

J. P. Loh; J. O. Haller; E. G. Kassner; A. Aloni; K. Glassberg

1977-01-01

106

Prostaglandin-induced foveolar hyperplasia simulating pyloric stenosis in an infant with cyanotic heart disease  

Microsoft Academic Search

Prostaglandin infusion is used to maintain patency of the ductus arteriosus in infants with cyanotic congenital heart disease. Recently, gastric outlet obstruction as a result of prostaglandin infusion has been described. In our case, an upper gastrointestinal contrast study seemed to depict the typical appearance of pyloric stenosis in an infant who had received an infusion of prostaglandin for a

M. G. Mercado-Deane; E. M. Burton; A. V. Brawley; R. Hatley

1994-01-01

107

Long-term outcome of endoscopic dilation of nonmalignant pyloric stenosis  

Microsoft Academic Search

Although the immediate success of endoscopic balloon dilation of nonmalignant and noncongenital pyloric stenosis is known, little information is available on the long-term results of such therapy. Of 19 patients who underwent this treatment at our institution for gastric outlet obstruction, 3 (16%) experienced sustained relief and 16 (84%) had a recurrence of symptoms during a median follow-up period of

Scott K. Kuwada; Glenn L. Alexander

1995-01-01

108

Hypertrophic Pyloric Stenosis developing In a Patient Operated for Patent Urachus - A Case Report.  

PubMed

A neonate with patent urachus (PU) who later developed hypertrophic pyloric stenosis (HPS) is being reported. The newborn was first operated for PU; post-operatively he developed persistent vomiting and radiological workup confirmed HPS. Pyloromyotomy was performed with an uneventful recovery. PMID:25057473

Jangid, Manoj Kumar; Khan, Yousuf Aziz; Yadav, Sunil Kumar; Taqi, Esmaeel

2014-05-01

109

Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: Impact of experience on the results in 182 cases  

Microsoft Academic Search

Background There has been discussion about the value of laparoscopic pyloromyotomy (LP) for the treatment of hypertrophic pyloric stenosis (HPS). In their initial small series, the authors reported a relatively high complication rate. The current study was undertaken to investigate the influence of experience with LP on operative time, complication rate, and postoperative hospital stay for a large number of

J. D. W. van der Bilt; W. L. M. Kramer; D. C. van der Zee; N. M. A. Bax

2004-01-01

110

Audit of results of operations for infantile pyloric stenosis in a district general hospital  

Microsoft Academic Search

Because of the proposal that infants with hypertrophic pyloric stenosis should only be treated by surgeons with an interest in paediatric surgery, we carried out a retrospective study to audit our experience in a district general hospital. Forty six infants over a five year period underwent pyloromyotomy. There were no deaths, and 36 infants (78%) made uneventful recoveries. Perforation of

C A Eriksen; C J Anders

1991-01-01

111

A rare occurrence of pyloric stenosis in an infant with osteogenesis imperfecta: Anesthetic implications.  

PubMed

Congenital anomalies pose many challenges during anesthesia due to anatomic and physiological alterations. The inherent complications associated with the disorders necessitate vigilance for providing anesthesia to even seemingly simple surgical intervention. Here, we share our experience of anesthesia management of an infant of congenital osteogenesis imperfecta with pyloric stenosis for pyloromyotomy. PMID:24803772

Jagtap, Sheetal R; Bakhshi, Rochana G; Jain, Ankit

2014-04-01

112

Laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis: Report of 11 cases  

Microsoft Academic Search

Pyloromyotomy remains the standard of care for the treatment of infantile hypertrophic pyloric stenosis. Open pyloromyotomy is effective and is the gold-standard technique. The authors report on the technique of laparoscopic pyloromyotomy. The clinical courses of the first 11 infants treated with laparoscopic pyloromyotomy were compared with the courses of 14 infants treated recently with open pyloromyotomy. The average surgical

Kevin L. Greason; W. Raleigh Thompson; Earl C. Downey; Barry Lo Sasso

1995-01-01

113

Pyloric stenosis in a patient with pure esophageal atresia: A difficult diagnosis.  

PubMed

Hypertrophic pyloric stenosis is brought to attention by its characteristic non-bilious vomiting. In a patient with pure esophageal atresia and a feeding gastrostomy, the symptoms were modified and the diagnosis was delayed. This case report highlights the clinical features of this rare combination, whose diagnosis was easily established once the entity was considered. PMID:24741218

Chattopadhyay, Anindya

2014-04-01

114

Laparoscopic extramucosal pyloromyotomy versus open pyloromyotomy for infantile hypertrophic pyloric stenosis: Which is better?  

Microsoft Academic Search

Background\\/Purpose: The aim of this study was to evaluate the advantages or disadvantages of laparoscopic pyloromyotomy compared with open transumbilical fold pyloromyotomy.Methods: Thirty consecutive laparoscopic extramucosal pyloromyotomies (LP) performed from 1994 to 1997 were compared with 30 consecutive open pyloromyotomies (OP) performed during the same period with regard to age at operation, body weight, thickness of hypertrophied pyloric muscle, operating

Takao Fujimoto; Osamu Segawa; Saori Esaki; Takeshi Miyano

1999-01-01

115

Relating Network Synaptic Connectivity and Network Activity in the Lobster (Panulirus interruptus) Pyloric Network  

E-print Network

Relating Network Synaptic Connectivity and Network Activity in the Lobster (Panulirus interruptus) Pyloric Network Adam L. Weaver and Scott L. Hooper Neuroscience Program, Department of Biological Sciences 2003 Weaver, Adam L. and Scott L. Hooper. Relating network synaptic connectivity and network activity

Hooper, Scott

116

Hypertrophic Pyloric Stenosis developing In a Patient Operated for Patent Urachus – A Case Report  

PubMed Central

A neonate with patent urachus (PU) who later developed hypertrophic pyloric stenosis (HPS) is being reported. The newborn was first operated for PU; post-operatively he developed persistent vomiting and radiological workup confirmed HPS. Pyloromyotomy was performed with an uneventful recovery. PMID:25057473

Jangid, Manoj Kumar; Yadav, Sunil Kumar; Taqi, Esmaeel

2014-01-01

117

A standardized feeding regimen for hypertrophic pyloric stenosis decreases length of hospitalization and hospital costs  

Microsoft Academic Search

Background\\/Purpose: Before the institution of a standardized feeding regimen (SFR) for hypertrophic pyloric stenosis (HPS) at the authors' institution, the postoperative feeding regimen and, thus, the length of hospitalization for HPS patients was variable. The aim of this study was to evaluate whether a SFR would affect the length of hospitalization or hospital costs for HPS patients. Methods: A 5-year

Michael J. Leinwand; Donald B. Shaul; Kathryn D. Anderson

2000-01-01

118

Ambulatory High Resolution Manometry, Lower Esophageal Sphincter Lift and Transient Lower Esophageal Sphincter Relaxation  

PubMed Central

Introduction Lower esophageal sphincter (LES) lift seen on high resolution manometry (HRM) is a possible surrogate marker of the longitudinal muscle contraction of the esophagus. Recent studies suggest that longitudinal muscle contraction of the esophagus induces LES relaxation. Aim Our goal was to determine, 1) the feasibility of prolonged ambulatory HRM and 2) to detect LES lift with LES relaxation using ambulatory HRM color isobaric contour plots. Methods In vitro validation studies were performed to determine the accuracy of HRM technique in detecting axial movement of the LES. Eight healthy normal volunteers were studied using a custom designed HRM catheter and a 16 channel data recorder, in the ambulatory setting of subject’s home environment. Color HRM plots were analyzed to determine the LES lift during swallow-induced LES relaxation as well as during complete and incomplete transient LES relaxations. Results Satisfactory recordings were obtained for 16 hours in all subjects. LES lift was small (2 mm) in association with swallow-induced LES relaxation. LES lift could not be measured during complete transient LES relaxations (TLESR) because the LES is not identified on the HRM color isobaric contour plot once it is fully relaxed. On the other hand, LES lift, mean 7.6 ± 1.4 mm, range 6–12 mm was seen with incomplete TLESRs (n = 80). Conclusions Our study demonstrates the feasibility of prolonged ambulatory HRM recordings. Similar to a complete TLESR, longitudinal muscle contraction of the distal esophagus occurs during incomplete TLESRs, which can be detected by the HRM. Using prolonged ambulatory HRM, future studies may investigate the temporal correlation between abnormal longitudinal muscle contraction and esophageal symptoms. PMID:22074595

Mittal, Ravinder K.; Karstens, Anna; Leslie, Eric; Babaei, Arash; Bhargava, Valmik

2011-01-01

119

Does an anatomical sphincter exist in the distal esophagus?  

Microsoft Academic Search

The presence or absence of a lower esophageal sphincter (LES) has been a matter of debate. The aim of the present study was\\u000a to revisit the gastro-esophageal region in an attempt to elucidate further the presence or absence of such a structure. The\\u000a distal part of the esophagus was investigated in 12 fixed and 2 fresh cadavers with the aid

Nihal Apaydin; Aysun Uz; Alaittin Elhan; Marios Loukas; R. Shane Tubbs

2008-01-01

120

A comparison of early gastric and post-pyloric feeding in critically ill patients: a meta-analysis  

Microsoft Academic Search

Objective  To investigate the potential beneficial and adverse effects of early \\u000apost-pyloric feeding compared with gastric feeding in critically ill adult \\u000apatients with no evidence of impaired gastric emptying.Design  Randomised controlled studies comparing gastric and post-pyloric feeding in \\u000acritically ill adult patients from Cochrane Controlled Trial Register (2005 \\u000aissue 3), EMBASE and MEDLINE databases (1966 to 1 October 2005) without any \\u000alanguage

Kwok M. Ho; Geoffrey J. Dobb; Steven A. R. Webb

2006-01-01

121

[Hypertrophic pyloric stenosis in infants. A retrospective study of cases observed in the years 1970-1990].  

PubMed

Although the definitive cause of infantile hypertrophic pyloric stenosis is unknown, it's probable that several predisposing risk factors would be associated with the condition. We analysed some perinatal factors in relation to the incidence of infantile hypertrophic pyloric stenosis among children observed during the period 1970-90. We examined 61 infants with surgically confirmed hypertrophic pyloric stenosis and, as controls, 61 healty children comparable for age. In every child we studied: sex, birth rank, pregnancy and delivery, birthweight, parental age, type of feeding, familial history of hypertrophic pyloric stenosis and of atopy, seasonal variation in incidence, AB0 and Rh blood phenotypes. In the 61 infants with hypertrophic pyloric stenosis, the incidence of three factors (male sex, primogeniture and feeding with artificial milk) was significantly higher than that in the controls. We conclude that infantile hypertrophic pyloric stenosis probably has a particular genetic basis, but perinatal factors are responsible for the rising of the condition. However the true aetiology remains to be elucidated. PMID:1461785

Ceccarelli, M; Villirillo, A; Assanta, N; Balsano, L; Chiaravalloti, G

1992-01-01

122

Control of a central pattern generator by an identified modulatory interneurone in crustacea. I. Modulation of the pyloric motor output.  

PubMed

In the lobsters Fasus lalandii and Palinurus vulgaris, the rhythmical activity of the pyloric pattern generator of the stomatogastric nervous system is strongly modified by the firing of a single identified interneurone, whose activity we have recorded from the cell body, in vitro. The cell body of this interneurone, the anterior pyloric modulator (APM), is located in the oesophageal ganglion and sends two axons to the stomatogastric ganglion via the inferior oesophageal nerves, the commissural ganglia, the superior oesophageal nerves and the stomatogastric nerve. Firing of neurone APM modifies the activity of all the neurones of the pyloric network, including pacemaker and follower neurones. Its effects are both quantitative (increase in the frequency of the rhythm and in the frequency of spikes within cell bursts) and qualitative (modifications in relative efficacies of the synaptic relationships within the pyloric network, which in turn lead to changes in the phase relationships between the discharges of the neurones). The effects on pyloric activity induced by firing of neurone APM are established slowly (one or two seconds) and are of long duration (ten times the duration of APM's discharge). These modifications most probably involve muscarinic cholinergic receptors. APM's influences on the activity of pyloric neurones appear to be characteristic of a neuromodulatory process and are such that they may be of behavioural significance in the intact animal. PMID:6619729

Nagy, F; Dickinson, P S

1983-07-01

123

Video capsule endoscopy and CT enterography in diagnosing adult hypertrophic pyloric stenosis  

PubMed Central

Primary adult hypertrophic pyloric stenosis is a rare but important cause of gastric outlet obstruction that may be misdiagnosed as idiopathic gastroparesis. Clinically, patients present with early satiety, abdominal fullness, nausea, epigastric discomfort and eructation. Permanent gastric retention of a video capsule endoscope is diagnostic in differentiating between the two diseases, in the absence of an organic gastric outlet obstruction. This case presents the longest video capsule retention in the medical literature to date. It is also the first case report of adult hypertrophic pyloric stenosis diagnosed with video capsule endoscopy or a computed tomography scan. Finally, an unusual “plugging” of the gastric outlet with free floating capsule has an augmented effect on disease physiology and on patient’s symptoms. PMID:24115829

Gurvits, Grigoriy E; Tan, Amy; Volkov, Dmitri

2013-01-01

124

Video capsule endoscopy and CT enterography in diagnosing adult hypertrophic pyloric stenosis.  

PubMed

Primary adult hypertrophic pyloric stenosis is a rare but important cause of gastric outlet obstruction that may be misdiagnosed as idiopathic gastroparesis. Clinically, patients present with early satiety, abdominal fullness, nausea, epigastric discomfort and eructation. Permanent gastric retention of a video capsule endoscope is diagnostic in differentiating between the two diseases, in the absence of an organic gastric outlet obstruction. This case presents the longest video capsule retention in the medical literature to date. It is also the first case report of adult hypertrophic pyloric stenosis diagnosed with video capsule endoscopy or a computed tomography scan. Finally, an unusual "plugging" of the gastric outlet with free floating capsule has an augmented effect on disease physiology and on patient's symptoms. PMID:24115829

Gurvits, Grigoriy E; Tan, Amy; Volkov, Dmitri

2013-10-01

125

Hypertrophic pyloric stenosis in an older child: a rare presentation with successful standard surgical management.  

PubMed

Infantile hypertrophic pyloric stenosis is a disease of neonatal period usually manifest between the third and fourth weeks of life. Metabolic alkalosis and paradoxical aciduria are two common sequel of this entity. We report an unusual case of an 8-year-old boy who presented with recurrent, long-standing episodes of non-bilious vomiting and poor weight gain without any other metabolic derangement. PMID:24259530

Bajpai, Minu; Singh, Amit; Panda, Shasanka Shekhar; Chand, Karunesh; Rafey, Abdul Rahman

2013-01-01

126

Slow Conductances Could Underlie Intrinsic Phase-Maintaining Properties of Isolated Lobster (Panulirus interruptus) Pyloric Neurons  

PubMed Central

The rhythmic pyloric network of the lobster stomatogastric system approximately maintains phase (that is, the burst durations and durations between the bursts of its neurons change proportionally) when network cycle period is altered by current injection into the network pacemaker (Hooper, 1997a,b). When isolated from the network and driven by rhythmic hyperpolarizing current pulses, the delay to firing after each pulse of at least one network neuron type (Pyloric, PY) varies in a phase-maintaining manner when cycle period is varied (Hooper, 1998). These variations require PY neurons to have intrinsic mechanisms that respond to changes in neuron activity on time scales at least as long as two seconds. Slowly activating and deactivating conductances could provide such a mechanism. We tested this possibility by building models containing various slow conductances. This work showed that such conductances could indeed support intrinsic phase-maintenance and we show here results for one such conductance, a slow potassium conductance. These conductances supported phase maintenance because their mean activation level changed, hence altering neuron post-inhibition firing delay, when the rhythmic input to the neuron changed. Switching the sign of the dependence of slow conductance activation and deactivation on membrane potential resulted in neuron delays switching to change in an anti-phase maintaining manner. These data suggest that slow conductances or similar slow processes such as changes in intracellular Ca2+ concentration could underlie phase maintenance in pyloric network neurons. PMID:19211890

Hooper, Scott L.; Buchman, Einat; Weaver, Adam L.; Thuma, Jeffrey B.; Hobbs, Kevin H.

2009-01-01

127

Functional abnormalities of the anal sphincters in patients with myotonic dystrophy.  

PubMed

Motility of the anorectal area was studied in 19 patients with myotonic dystrophy and in 20 control subjects, before and after pudendal block. In patients with myotonic dystrophy, before anesthesia, resting pressure in the upper anal canal ( p less than 0.001) and duration and amplitude of relaxation of the rectoanal inhibitory reflex (p less than 0.01) were decreased. A myotonic contraction of high amplitude followed relaxation in all patients, but in control subjects this was not the case. In the lower anal canal, the duration of the rectoanal contractile reflex was prolonged as compared with control subjects (p less than 0.001). The pudendal block had no effect in the upper anal canal either on resting pressure or on amplitude and duration of the rectoanal inhibitory reflex, neither in patients nor in controls. After blockade, however, the myotonic contraction subsequent to the reflex in patients was significantly reduced in amplitude (p less than 0.01). In lower anal canal, the resting pressure was reduced to similar levels, both in patients and in control subjects, after pudendal block (p less than 0.01), and the rectoanal contractile reflex was abolished in both groups. This study demonstrates a number of functional abnormalities in the anorectal structures of patients with myotonic dystrophy. These abnormalities produce a decrease in resting pressure in the anal canal, and a reflex myotonic contraction subsequent to rectal distention due to both external and internal sphincter dysfunction. PMID:6714574

Hamel-Roy, J; Devroede, G; Arhan, P; Tétreault, J P; Lemieux, B; Scott, H

1984-06-01

128

Characterization of the Upper Esophageal Sphincter Response During Cough  

PubMed Central

Background: Vagal reflex initiated by esophageal stimulation and microaspiration can cause chronic cough in patients with gastroesophageal reflux disease (GERD). By raising intraabdominal pressure, cough can, in turn, predispose to GERD. The role of the upper esophageal sphincter (UES) in preventing esophagopharyngeal reflux during coughing is not well known. The aim of this study was to evaluate the UES response during coughing. Methods: We studied 20 healthy young (10 women; age, 27 ± 5 years) and 15 healthy elderly (nine women; age, 73 ± 4 years) subjects. Hard and soft cough-induced pressure changes in the UES, distal esophagus, lower esophageal sphincter, and stomach were determined simultaneously using high-resolution manometry and concurrent acoustic cough recordings. Results: Resting UES pressure was significantly higher in the young compared with the elderly subjects (42 ± 14 mm Hg vs 24 ± 9 mm Hg; P < .001). Cough induced a UES contractile response in all subjects. Despite lower UES resting pressures in the elderly subjects, the maximum UES pressure during cough was similar between the young and the elderly subjects (hard cough, 230 ± 107 mm Hg vs 278 ± 125 mm Hg, respectively; soft cough, 156 ± 85 mm Hg vs 164 ± 119 mm Hg, respectively; P not significant for both). The UES pressure increase over baseline during cough was significantly higher than that in the esophagus, lower esophageal sphincter, and stomach for both groups (P < .001). Conclusions: Cough induces a rise in UES pressure, and this response is preserved in elderly people. A cough-induced rise in UES pressure is significantly higher than that in the esophagus and stomach, thereby providing a barrier against retrograde entry of gastric contents into the pharynx. PMID:22797662

Amaris, Manuel; S. Dua, Kulwinder; Naini, Sohrab Rahimi; Samuel, Erica

2012-01-01

129

Roles of sphincter of Oddi motility and serum vasoactive intestinal peptide, gastrin and cholecystokinin octapeptide  

PubMed Central

AIM: To investigate roles of sphincter of Oddi (SO) motility played in pigment gallbladder stone formation in model of guinea pigs. METHODS: Thirty-four adult male Hartley guinea pigs were divided randomly into two groups: the control group and pigment stone group. The pigment stone group was divided into 4 subgroups with 6 guinea pigs each according to time of sacrifice, and were fed a pigment lithogenic diet and sacrificed after 3, 6, 9 and 12 wk. SO manometry and recording of myoelectric activity of the guinea pigs were obtained by multifunctional physiograph at each stage. Serum vasoactive intestinal peptide (VIP), gastrin and cholecystokinin octapeptide (CCK-8) were detected at each stage in the process of pigment gallbladder stone formation by enzyme-linked immunosorbent assay. RESULTS: The incidence of pigment gallstone formation was 0%, 0%, 16.7% and 66.7% in the 3-, 6-, 9- and 12-wk group, respectively. The frequency of myoelectric activity decreased in the 3-wk group. The amplitude of myoelectric activity had a tendency to decrease but not significantly. The frequency of the SO decreased significantly in the 9-wk group. The SO basal pressure and common bile duct pressure increased in the 12-wk group (25.19 ± 7.77 mmHg vs 40.56 ± 11.81 mmHg, 22.35 ± 7.60 mmHg vs 38.51 ± 11.57 mmHg, P < 0.05). Serum VIP was significantly elevated in the 6- and 12-wk groups and serum CCK-8 was decreased significantly in the 12-wk group. CONCLUSION: Pigment gallstone-causing diet may induce SO dysfunction. The tension of the SO increased. The disturbance in SO motility may play a role in pigment gallstone formation, and changes in serum VIP and CCK-8 may be important causes of SO dysfunction. PMID:24782626

Zhang, Zhen-Hai; Qin, Cheng-Kun; Wu, Shuo-Dong; Xu, Jian; Cui, Xian-Ping; Wang, Zhi-Yi; Xian, Guo-Zhe

2014-01-01

130

Constipation in 44 patients implanted with an artificial bowel sphincter  

Microsoft Academic Search

Purpose  Constipation with or without obstructed defecation (OD) is frequent in patients with artificial bowel sphincter (ABS). The\\u000a aims of this study were (1) to evaluate the functional outcome of ABS based on postoperative constipation and (2) to assess\\u000a pre-implantation data to predict post-implantation constipation.\\u000a \\u000a \\u000a \\u000a Materials and methods  Thirteen men and 31 women were followed up. Both fecal incontinence and constipation with

Syrine Gallas; Anne-Marie Leroi; Valérie Bridoux; Benoît Lefebure; Jean-Jacques Tuech; Françis Michot

2009-01-01

131

Effect of Pituitary Adenylate Cyclase-Activating Peptide on Isolated Rabbit Iris Sphincter and Dilator Muscles  

Microsoft Academic Search

PURPOSE. Pituitary adenylate cyclase-activating peptide (PACAP) is a sensory neuropeptide in the eye that is released by noxious stimuli and considered to be a mediator of the neurogenic ocular injury response, including miosis. The pur- pose of this study was to clarify the functional role of PACAP in iris sphincter and dilator muscles. METHODS. Iris sphincter and dilator muscles were

Takeshi Yoshitomi; Kazutsuna Yamaji; Hitoshi Ishikawa; Yoshitaka Ohnishi

132

Abnormal transient internal sphincter relaxation in idiopathic pruritus ani: physiological evidence from ambulatory monitoring.  

PubMed

Patients with idiopathic pruritus ani have an abnormal rectoanal inhibitory reflex and a lower threshold for internal sphincter relaxation during the saline continence test. This led to the hypothesis that these patients may exhibit abnormalities of the transient internal anal sphincter relaxation reflex. To study this, 23 men of median age 41 (range 27-64) years with idiopathic pruritus ani and 16 male controls of median age 39 (range 26-68) years were assessed using computerized ambulatory anorectal electromyography and manometry. Resting anal pressure, maximum anal squeeze pressure, internal sphincter electromyogram frequency, the number of internal sphincter relaxations and pudendal nerve terminal motor latency were similar for the two groups. The rise in rectal pressure during internal sphincter relaxation was higher in patients with pruritus than in controls (median (range) 29 (18-60) versus 18 (11-37) cmH2O, P < 0.01). Furthermore, the fall in anal pressure was greater in patients with pruritus than in controls (median (range) 39 (15-52) versus 29 (21-43) cmH2O, P < 0.01). The duration of internal sphincter relaxation was prolonged in patients compared with controls (median (range) 29 (18-55) versus 8 (5-12) s, P < 0.001). Fourteen patients reported staining of underclothes and 17 complained of perianal itch within 1 h of these episodes of abnormal internal sphincter relaxation. Pruritus ani may result from occult faecal leakage as a result of abnormal transient internal sphincter relaxation. PMID:8205448

Farouk, R; Duthie, G S; Pryde, A; Bartolo, D C

1994-04-01

133

Influence of pudendal block on the function of the anal sphincters  

Microsoft Academic Search

The function of the anal sphincters has been studied by obtaining continuous recordings of the pressure in the anal canal and the electromyographic activity in the striated sphincter muscles during expansion of the ampulla recti by means of an air balloon. Ten healthy subjects were examined before and after the striated muscles had been entirely paralysed by bilateral pudendal block,

B Frenckner; C V Euler

1975-01-01

134

Successful Implantation of Bioengineered, Intrinsically Innervated, Human Internal Anal Sphincter  

PubMed Central

Background & Aims To restore fecal continence, the weakened pressure of the internal anal sphincter (IAS) must be increased. We bioengineered intrinsically innervated human IAS, to emulate sphincteric physiology, in vitro. Methods We co-cultured human IAS circular smooth muscle with immortomouse fetal enteric neurons. We investigated the ability of bioengineered innervated human IAS, implanted in RAG1?/? mice, to undergo neovascularization and preserve the physiology of the constituent myogenic and neuronal components. Results The implanted IAS was neovascularized in vivo; numerous blood vessels were observed with no signs of inflammation or infection. Real-time force acquisition from implanted and pre-implant IAS showed distinct characteristics of IAS physiology. Features included the development of spontaneous myogenic basal tone; relaxation of 100% of basal tone in response to inhibitory neurotransmitter vasoactive intestinal peptide (VIP) and direct electrical field stimulation of the intrinsic innervation; inhibition of nitrergic and VIPergic EFS-induced relaxation (by antagonizing nitric oxide synthesis or receptor interaction); contraction in response to cholinergic stimulation with acetylcholine; and intact electromechanical coupling (evidenced by direct response to potassium chloride). Implanted, intrinsically innervated bioengineered human IAS tissue preserved the integrity and physiology of myogenic and neuronal components. Conclusion Intrinsically innervated human IAS bioengineered tissue can be successfully implanted in mice. This approach might be used to treat patients with fecal incontinence. PMID:21463628

Raghavan, Shreya; Gilmont, Robert R.; Miyasaka, Eiichi A.; Somara, Sita; Srinivasan, Shanthi; Teitelbaum, Daniel H; Bitar, Khalil N.

2011-01-01

135

Gustatory dysfunction.  

PubMed

Tastes in humans provide a vital tool for screening soluble chemicals for food evaluation, selection, and avoidance of potentially toxic substances. Taste or gustatory dysfunctions are implicated in loss of appetite, unintended weight loss, malnutrition, and reduced quality of life. Dental practitioners are often the first clinicians to be presented with complaints about taste dysfunction. This brief review provides a summary of the common causes of taste disorders, problems associated with assessing taste function in a clinical setting and management options available to the dental practitioner. PMID:25210380

Maheswaran, T; Abikshyeet, P; Sitra, G; Gokulanathan, S; Vaithiyanadane, V; Jeelani, S

2014-07-01

136

[Case of early antral gastric cancer diagnosed during follow up of pyloric stenosis by the gastro-duodenal ulcer].  

PubMed

A 65-year-old man was admitted to our hospital with nausea, vomiting and appetite loss. First upper endoscopic examination and X-ray examination showed a peptic ulcer and a pyloric stenosis. Fiberscope could not go through the pyloric ring. Computed tomography examination and biopsy showed no evidence of malignancy. Though we considered surgical resection of the stenosis at first, he could eat a staple food with therapy of proton pump inhibitor. So we followed up with upper endoscopic examinations. Second, third and forth upper endoscopic examinations showed no evidence of malignancy. Fifth upper endoscopic examination showed an ulcer scar on the pyloric ring and a 0-IIc carcinoma in the antral greater curvature. Distal gastrectomy with D2 lymph node dissection and B-II reconstruction. Pathologically, a mucosal carcinoma with no lymph node metastasis and U1-III peptic ulcer were diagnosed. PMID:24693690

Kabashima, Akira; Kitagawa, Dai; Nakamura, Toshihiko; Kondou, Naoko; Shoji, Fumihiro; Hasegawa, Hirofumi; Teramoto, Seiichi; Funahashi, Satoru; Ikeda, Youichi; Saeki, Hiroshi; Oki, Eiji; Morita, Masaru; Ikeda, Tetsuo; Maehara, Yoshihiko

2013-12-01

137

A review of postoperative feeding regimens in infantile hypertrophic pyloric stenosis.  

PubMed

Infantile hypertrophic pyloric stenosis is a condition well known to pediatric surgeons. Postoperative length of hospital stay is a financial concern and remains a potential target for reduction in hospital costs. Ultimately, these costs are directly affected by the ability to effectively advance postoperative enteral nutrition. This review will serve to: 1) identify clinically relevant postoperative feeding patterns following pyloromyotomy, 2) review the relevant literature to determine an optimal feeding pattern, and 3) identify possible preoperative predictors that may determine the success of postoperative feeding regiments. PMID:24094977

Graham, Kevin A; Laituri, Carrie A; Markel, Troy A; Ladd, Alan P

2013-10-01

138

Sphincter Preservation in Anal Cancer: A Brief Review  

PubMed Central

Management of anal cancer is a challenge. The goal of treatment is to eradicate tumor without sacrificing the anal sphincters. The idea of organ preservation emerged following the discovery of a high complete response rate from preoperative combined chemoradiation (CRT) prior to abdominoperineal resection. CRT is widely accepted as the standard therapy for treating anal squamous cell cancer. The combination of external beam radiotherapy with interstitial brachytherapy increases the dose to the tumor volume and decreases dose to normal tissues. The current goal is to avoid colostomy, and surgery has become a salvage or secondary therapy. In this article, we review the non-surgical management of anal cancer with special emphasis on CRT, role of intensity modulated radiation therapy and brachytherapy. PMID:23680706

Khosla, Divya; Kumar, Ritesh; Kapoor, Rakesh; Sharma, Suresh C.

2013-01-01

139

Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women  

PubMed Central

Objective To compare the function of the pelvic floor in primiparae before and during pregnancy with the status post partum concerning symptoms of incontinence, sphincter ruptures, bladder-neck mobility and the influence of the different modes of deliveries. Methods Questionnaire evaluating symptoms of urinary and anal incontinence in nulliparous women before and after delivery and correlating these symptoms with functional changes of the pelvic floor based on a careful gynaecologic examination as well as perineal and endoanal ultrasound. Results 112 women were included in our study and came for the first visit, 99 women returned for follow-up 6 months after childbirth. Stress and flatus incontinence significantly increased from before pregnancy (3 and 12%) to after childbirth (21 and 28%) in women with spontaneous delivery or vacuum extraction. No new symptoms occurred after c-section. There was no significant difference between the bladder neck position before and after delivery. The mobility of the bladder neck was significantly higher after vaginal delivery using a vacuum extraction compared to spontaneous delivery or c-section. The bladder neck in women with post partum urinary stress incontinence was significantly more mobile than in continent controls. The endoanal ultrasound detected seven occult sphincter defects without any correlation to symptoms of anal incontinence. Conclusion Several statistically significant changes of the pelvic floor after delivery were demonstrated. Spontaneous vaginal delivery or vacuum extraction increases the risk for stress or anal incontinence, delivery with vacuum extraction leads to higher bladder neck mobility and stress incontinent women have more mobile bladder necks than continent women. PMID:20696633

2010-01-01

140

Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction  

PubMed Central

Nonrelaxing pelvic floor dysfunction is not widely recognized. Unlike in pelvic floor disorders caused by relaxed muscles (eg, pelvic organ prolapse or urinary incontinence, both of which often are identified readily), women affected by nonrelaxing pelvic floor dysfunction may present with a broad range of nonspecific symptoms. These may include pain and problems with defecation, urination, and sexual function, which require relaxation and coordination of pelvic floor muscles and urinary and anal sphincters. These symptoms may adversely affect quality of life. Focus on the global symptom complex, rather than the individual symptoms, may help the clinician identify the condition. The primary care provider is in a position to intervene early, efficiently, and effectively by (1) recognizing the range of symptoms that might suggest nonrelaxing pelvic floor dysfunction, (2) educating patients, (3) performing selective tests when needed to confirm the diagnosis, and (4) providing early referral for physical therapy. PMID:22305030

Faubion, Stephanie S.; Shuster, Lynne T.; Bharucha, Adil E.

2012-01-01

141

In vitro and in vivo assessment of an intelligent artificial anal sphincter in rabbits.  

PubMed

Artificial sphincters have been developed for patients with fecal incontinence, but finding a way to make such sphincters more "intelligent" remains a problem. We assessed the function of a novel intelligent artificial anal sphincter (IAAS) in vitro and in vivo in rabbits. After the prosthesis was activated, rabbits were continent of feces during 81.4% of the activation time. The fecal detection unit provided 100% correct signals on stool in vitro and 65.7% in vivo. The results indicated that the IAAS could efficiently maintain continence and detect stool; however, the IAAS is still in the preliminary experimental stage and more work is needed to improve the system. PMID:21507023

Huang, Zong-Hai; Shi, Fu-Jun; Chen, Fei; Liang, Fei-Xue; Li, Qiang; Yu, Jin-Long; Li, Zhou; Han, Xin-Jun

2011-10-01

142

Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes  

PubMed Central

The present study assesses the choice of surgical procedure, oncologic results and quality of life (QOL) outcomes in a retrospective cohort of 53 patients with low-lying rectal cancers (within 6 cm of the anal verge) treated surgically following preoperative radiotherapy (RT, median dose 45 Gy) with or without concomitant 5-fluorouracil. QOL was assessed in 23 patients by using two questionnaires developed by the QOL Study Group of the European Organization for Research and Treatment of Cancer: EORTC QLQ-C30 and EORTC QLQ-CR38. After a median interval of 29 days from completion of RT, abdominoperineal resection (APR) was performed in 29 patients (55%), low anterior resection in 23 patients (20 with coloanal anastomosis) and transrectal excision in one patient. The 3-year actuarial overall survival and locoregional control rates were 71.4% and 77.5% respectively, with no differences observed between patients operated by APR or restorative procedures. For all scales of EORTC QLQ-C30 and EORTC QLQ-CR38, no significant differences in median scores were observed between the two surgical groups. Although patients having had APR tended to report a lower body image score (P = 0.12) and more sexual dysfunction in male patients, all APR patients tended to report better physical function, future perspective and global QOL. In conclusion, sphincter-sparing surgery after preoperative RT seems to be feasible, in routine practice, in a significant proportion of low rectal cancers without compromising the oncologic results. However, prospective studies are mandatory to confirm this finding and to clarify the putative QOL advantages of sphincter-conserving approaches. © 2000 Cancer Research Campaign PMID:10735495

Allal, A S; Bieri, S; Pelloni, A; Spataro, V; Anchisi, S; Ambrosetti, P; Sprangers, M A G; Kurtz, J M; Gertsch, P

2000-01-01

143

Long-term recording of external urethral sphincter EMG activity in unanesthetized, unrestrained rats.  

PubMed

The external urethral sphincter muscle (EUS) plays an important role in urinary function and often contributes to urinary dysfunction. EUS study would benefit from methodology for longitudinal recording of electromyographic activity (EMG) in unanesthetized animals, but this muscle is a poor substrate for chronic intramuscular electrodes, and thus the required methodology has not been available. We describe a method for long-term recording of EUS EMG by implantation of fine wires adjacent to the EUS that are secured to the pubic bone. Wires pass subcutaneously to a skull-mounted plug and connect to the recording apparatus by a flexible cable attached to a commutator. A force transducer-mounted cup under a metabolic cage collected urine, allowing recording of EUS EMG and voided urine weight without anesthesia or restraint. Implant durability permitted EUS EMG recording during repeated (up to 3 times weekly) 24-h sessions for more than 8 wk. EMG and voiding properties were stable over weeks 2-8. The degree of EUS phasic activity (bursting) during voiding was highly variable, with an average of 25% of voids not exhibiting bursting. Electrode implantation adjacent to the EUS yielded stable EMG recordings over extended periods and eliminated the confounding effects of anesthesia, physical restraint, and the potential for dislodgment of the chronically implanted intramuscular electrodes. These results show that micturition in unanesthetized, unrestrained rats is usually, but not always, associated with EUS bursting. This methodology is applicable to studying EUS behavior during progression of gradually evolving disease and injury models and in response to therapeutic interventions. PMID:24990895

LaPallo, Brandon K; Wolpaw, Jonathan R; Chen, Xiang Yang; Carp, Jonathan S

2014-08-15

144

Quantification of Cardiac Sac Network Effects on a Movement-Related Parameter of Pyloric Network Output in the Lobster  

E-print Network

Quantification of Cardiac Sac Network Effects on a Movement- Related Parameter of Pyloric Network 29 September 2002 Thuma, Jeff B. and Scott L. Hooper. Quantification of cardiac sac network effects.1152/jn.00631.2002. Cardiac sac network activity (cycle period tens of seconds to minutes) has long been

Hooper, Scott

145

Changing patterns of diagnosis and treatment of infantile hypertrophic pyloric stenosis: A clinical audit of 303 patients  

Microsoft Academic Search

This review of 303 patients with infantile hypertrophic pyloric stenosis (IHPS) concentrates on the influence of clinical audit on diagnosis, complications, and factors contributing to hospital stay. Although the audit has enabled improvement in care by pediatric surgeons, there has been less change in areas controlled by other specialities. During a 12-year period, the number of patients diagnosed solely by

Terence S. C. Poon; An-Ling Zhang; Tim Cartmill; Daniel T. Cass

1996-01-01

146

Maternal and infant use of erythromycin and other macrolide antibiotics as risk factors for infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

Objectives: To evaluate the risk for infantile hypertrophic pyloric stenosis (IHPS) among infants prescribed systemic erythromycin, infants prescribed a course of erythromycin ophthalmic ointment, and infants whose mothers were prescribed a macrolide antibiotic during pregnancy. Study design: Retrospective cohort study of infants born at an urban hospital from June 1993 through December 1999. Results: Of 14,876 eligible infants, 43 (0.29%)

Barbara E. Mahon; Marc B. Rosenman; Martin B. Kleiman

2001-01-01

147

Molecular Underpinnings of Motor Pattern Generation: Differential Targeting of Shal and Shaker in the Pyloric Motor System  

Microsoft Academic Search

The patterned activity generated by the pyloric circuit in the stomatogastric ganglion of the spiny lobster, Panulirus interrup- tus, results not only from the synaptic connectivity between the 14 component neurons but also from differences in the intrinsic properties of the neurons. Presumably, differences in the com- plement and distribution of expressed ion channels endow these neurons with many of

Deborah J. Baro; Amir Ayali; Lauren French; Nathaniel L. Scholz; Jana Labenia; Cathy C. Lanning; Katherine Graubard; Ronald M. Harris-Warrick

2000-01-01

148

New Artificial Urinary Sphincter Devices in the Treatment of Male Iatrogenic Incontinence  

PubMed Central

Severe persistent stress incontinence following radical prostatectomy for prostate cancer treatment, although not very common, remains the most annoying complication affecting patient's quality of life, despite good surgical oncological results. When severe incontinence persists after the first postoperative year and conservative treatment has been failed, surgical treatment has to be considered. In these cases it is generally accepted that artificial urinary sphincter is the gold standard treatment. AUS 800 by American Medical Systems has been successfully used for more than 35 years. Recently three more sphincter devices, the Flow-Secure, the Periurethral Constrictor, and the ZSI 375, have been developed and presented in the market. A novel type of artificial urinary sphincter, the Tape Mechanical Occlusive Device, has been inserted in live canines as well as in human cadavers. These new sphincter devices are discussed in this paper focusing on safety and clinical results. PMID:22567002

Vakalopoulos, Ioannis; Kampantais, Spyridon; Laskaridis, Leonidas; Chachopoulos, Vasileios; Koptsis, Michail; Toutziaris, Chrysovalantis

2012-01-01

149

New artificial urinary sphincter devices in the treatment of male iatrogenic incontinence.  

PubMed

Severe persistent stress incontinence following radical prostatectomy for prostate cancer treatment, although not very common, remains the most annoying complication affecting patient's quality of life, despite good surgical oncological results. When severe incontinence persists after the first postoperative year and conservative treatment has been failed, surgical treatment has to be considered. In these cases it is generally accepted that artificial urinary sphincter is the gold standard treatment. AUS 800 by American Medical Systems has been successfully used for more than 35 years. Recently three more sphincter devices, the Flow-Secure, the Periurethral Constrictor, and the ZSI 375, have been developed and presented in the market. A novel type of artificial urinary sphincter, the Tape Mechanical Occlusive Device, has been inserted in live canines as well as in human cadavers. These new sphincter devices are discussed in this paper focusing on safety and clinical results. PMID:22567002

Vakalopoulos, Ioannis; Kampantais, Spyridon; Laskaridis, Leonidas; Chachopoulos, Vasileios; Koptsis, Michail; Toutziaris, Chrysovalantis

2012-01-01

150

How does preoperative radiotherapy affect the rate of sphincter-sparing surgery in rectal cancer?  

PubMed

The use of preoperative radiotherapy has resulted in significant downstaging and downsizing of tumor, this in turn facilitated resections permitting sphincter preservation and coloanal anastomosis for patients who would otherwise have not been candidates for this type of surgery as concluded by some small studies. On the other hand, other clinical trials have shown that the effect of radiotherapy on the rate of sphincter preservation is still not clear. Moreover, different modes of radiotherapy have been tested on the rate of sphincter preservation such as pelvic irradiation with or without combination of chemotherapy, short or conventional course radiotherapy, and preoperative or postoperative radiotherapy with different timing intervals of surgery. Unfortunately, these trials didn't clearly answer the question of radiotherapy benefit for the sake of sphincter preserving of rectal cancer patients and the question remained hotly debated. PMID:22534311

Baker, Bilal; Salameh, Habeeb; Al-Salman, Mohammad; Daoud, Faiez

2012-09-01

151

POLYARTERITIS NODOSA AND CONGENITAL PYLORIC HYPERTROPHY IN A 3-MONTH-OLD INFANT  

PubMed Central

A case of polyarteritis nodosa in the first year of life with the clinical picture dominated by pyrexia, an initial upper respiratory element, episodes of tachycardia, and sudden death three weeks after the onset is described. The necropsy showed evidence of polyarteritis nodosa, myocarditis, and valvulitis as well as congenital pyloric hypertrophy. Clinical manifestations of the latter had preceded the final illness and the two diseases were not thought to be related. The previous 19 cases reported in the first year of life are reviewed, and support is given for the concept that at this age a rash, pyrexia, upper respiratory manifestations, and progressive heart failure or sudden death are characteristic clinical manifestations and that the heart is often the site of the major lesions at necropsy. The possible role of hypersensitivity is discussed. There was no evidence for it in the present case. Images PMID:14442009

Savage, T. R.; Smith, J. F.

1960-01-01

152

Laparoscopic gastric resection with natural orifice specimen extraction for postulcer pyloric stenosis.  

PubMed

Although natural orifice specimen extraction is now relatively widely performed, there have been no reports on gastric resection with specimen extraction through the transgastric route for peptic ulcer disease. A hybrid technique of the laparoscopic and endoscopic approach is presented in the case of a 58-year old male patient. Preoperative gastric fibroscopy showed postulcer pyloric and antral stenosis. Laparoscopic exploration confirmed gastric enlargement. Laparoscopic two-thirds gastrectomy was performed. The staple line suture of the residual stomach was excised and the specimen was extracted through the esophagus and mouth with a gastroscope. Finally, the residual stomach was closed again using linear endostaplers. Reconstruction was performed according to the Roux-en-Y method. Gastric resection using natural orifice specimen extraction (NOSE) may be a feasible operative procedure. The NOSE with the combination of standard laparoscopy and specimen extraction through a natural orifice can be considered as a bridge to natural orifice translumenal endoscopic surgery. PMID:25097701

Dostalik, Jan; Gunkova, Petra; Gunka, Igor; Mazur, Miloslav; Mrazek, Tomas

2014-06-01

153

Temperature Sensitivity of the Pyloric Neuromuscular System and Its Modulation by Dopamine  

PubMed Central

We report here the effects of temperature on the p1 neuromuscular system of the stomatogastric system of the lobster (Panulirus interruptus). Muscle force generation, in response to both the spontaneously rhythmic in vitro pyloric network neural activity and direct, controlled motor nerve stimulation, dramatically decreased as temperature increased, sufficiently that stomach movements would very unlikely be maintained at warm temperatures. However, animals fed in warm tanks showed statistically identical food digestion to those in cold tanks. Applying dopamine, a circulating hormone in crustacea, increased muscle force production at all temperatures and abolished neuromuscular system temperature dependence. Modulation may thus exist not only to increase the diversity of produced behaviors, but also to maintain individual behaviors when environmental conditions (such as temperature) vary. PMID:23840789

Thuma, Jeffrey B.; Hobbs, Kevin H.; Burstein, Helaine J.; Seiter, Natasha S.; Hooper, Scott L.

2013-01-01

154

Topical glyceryl trinitrate relaxes the sphincter of Oddi.  

PubMed Central

BACKGROUND/AIM: Nitric oxide (NO) may be involved in non-adrenergic non-cholinergic (NANC) inhibitory innervation of the sphincter of Oddi (SO). The effects of topical application of glyceryl trinitrate (GTN), a NO donor, upon SO motility were examined. METHODS: Nineteen patients undergoing routine SO manometry for investigation of abdominal pain were studied. After routine recording of SO motility, they were randomised into three groups to receive 10 ml of normal saline, 5 mg GTN (0.5 mg/ml) or 10 mg (1 mg/ml) GTN. Drug solutions were infused topically onto papilla via the manometry catheter and recordings were continued for a further 5 minutes. RESULTS: There was no significant change in SO motor variables following application of normal saline. GTN reduced SO tonic and phasic contractions. In four patients, there was complete abolition of all phasic contraction. CONCLUSIONS: Local application of GTN inhibits SO motility. This may have application for diagnostic and therapeutic biliary endoscopy. PMID:9176086

Luman, W; Pryde, A; Heading, R C; Palmer, K R

1997-01-01

155

Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence  

PubMed Central

While anal sphincter neurogenic injury documented by needle electromyography (EMG) has been implicated to cause fecal incontinence (FI), most studies have been uncontrolled. Normal values and the effects of age on anal sphincter motor unit potentials (MUP) are ill defined. The functional significance of anal sphincter neurogenic injury in FI is unclear. Anal pressures and EMG were assessed in 20 asymptomatic nulliparous women (age, 38 ± 5 yr; mean ± SE) and 20 women with FI (54 ± 3 yr). A computerized program quantified MUP duration and phases. These parameters and MUP recruitment were also semiquantitatively assessed by experienced electromyographers in real time. Increasing age was associated with longer and more polyphasic MUP in nulliparous women by quantitative analysis. A higher proportion of FI patients had prolonged (1 control, 7 patients, P = 0.04) and polyphasic MUP (2 controls, 9 patients, P = 0.03) at rest but not during squeeze. Semiquantitative analyses identified neurogenic or muscle injury in the anal sphincter (11 patients) and other lumbosacral muscles (4 patients). There was substantial agreement between quantitative and semiquantitative analyses (? statistic 0.63 ± 95% CI: 0.32–0.96). Anal resting and squeeze pressures were lower (P ? 0.01) in FI than controls. Anal sphincter neurogenic or muscle injury assessed by needle EMG was associated (P = 0.01) with weaker squeeze pressures (83 ± 10 mmHg vs. 154 ± 30 mmHg) and explained 19% (P = 0.01) of the variation in squeeze pressure. Anal sphincter MUP are longer and more polyphasic in older than younger nulliparous women. Women with FI have more severe neurogenic or muscle anal sphincter injury, which is associated with lower squeeze pressures. PMID:22575218

Daube, Jasper; Litchy, William; Traue, Julia; Edge, Jessica; Enck, Paul; Zinsmeister, Alan R.

2012-01-01

156

Dysfunctional voiding: A review of the terminology, presentation, evaluation and management in children and adults  

PubMed Central

Dysfunctional voiding (DV) is a voiding disorder characterized by dyssynergic striated sphincteric activity in the absence of a proven neurological etiology. It can present at any age with a spectrum of storage and voiding symptoms that may resemble florid neurogenic bladder. There is a striking lack of clarity regarding what this entity represents, the diagnostic methodology and treatment. The limitations of existing guideline documents are analyzed. Specifically, use of the term “habitual”, the assumption that bladder changes are secondary to the outlet, the emphasis on “staccato” voiding and the implication of striated urethral sphincter are discussed. Literature shows that DV may also present with continuous slow flow or normal flow. Dyssynergia may be at the level of the striated urethral sphincter, the pelvic floor or both, better termed “striated urethral sphincter-pelvic floor complex” (SUS-PFC).A diagnostic algorithm is provided so that patients are evaluated on merit rather than on the basis of different philosophies of individual centers. High-risk markers such as hydronephrosis, vesicoureteral reflux, renal failure or marked voiding difficulty should prompt a formal urodynamics evaluation and imaging for neurological etiology. Patients with predominantly storage symptoms with incidental staccato voiding can be managed initially, on the basis of non-invasive evaluation. Conservative urotherapy including biofeedback is appropriate initial management for patients without high risk factors. Treatment and evaluation should be escalated based on response. Patients with severe DV will need treatment similar to neurogenic bladder including clean intermittent catheterization and measures to control storage pressures. PMID:22279306

Sinha, Sanjay

2011-01-01

157

Expression of serotonin receptors in human lower esophageal sphincter  

PubMed Central

Serotonin (5-HT) is a neurotransmitter and vasoactive amine that is involved in the regulation of a large number of physiological functions. The wide variety of 5-HT-mediated functions is due to the existence of different classes of serotonergic receptors in the mammalian gastrointestinal tract and nervous system. The aim of this study was to explore the expression of multiple types of 5-HT receptor (5-HT1AR, 5-HT2AR, 5-HT3AR, 5-HT4R, 5-HT5AR, 5-HT6R and 5-HT7R) in sling and clasp fibers from the human lower esophageal sphincter (LES). Muscle strips of sling and clasp fibers from the LES were obtained from patients undergoing esophagogastrectomy, and circular muscle strips from the esophagus and stomach were used as controls. Reverse transcription-polymerase chain reaction (RT-PCR), quantitative PCR and western blotting were used to investigate the expression of the various 5-HT receptor types. Messenger RNA for all seven 5-HT receptor types was identified in the sling and clasp fibers of the LES. At the mRNA level, the expression levels were highest for 5-HT3AR and 5-HT4R, and lowest for 5-HT5AR, 5-HT6R and 5-HT7R. At the protein level, the expression levels were highest for 5-HT3AR and 5-HT4R, followed by 5-HT1AR and 5-HT2AR; 5-HT7R was also detected at a low level. The expression of 5-HT5AR and 5-HT6R proteins was not confirmed. The results indicate that a variety of 5-HT receptor types can be detected in the human LES and probably contribute to LES function.

LI, HE-FEI; LIU, JUN-FENG; ZHANG, KE; FENG, YONG

2015-01-01

158

Comparative anti-ulcerogenic study of pantoprazole formulation with and without sodium bicarbonate buffer on pyloric ligated rat  

PubMed Central

Objective: To compare the anti-ulcer activity of buffered pantoprazole tablet against plain pantoprazole in pyloric ligated rats. Materials and Methods: In vivo pyloric ligated ulcerogenesis model was used to assess the effect of buffered pantoprazole on the volume of the gastric content, pH, total and free acidity, and ulcerogenic lesion. Pantoprazole level in gastric content and concurrently in stomach tissue was assessed by High Performance Liquid Chromatography (HPLC) analysis. Results: Buffered tablet effectively increases the pH of the gastric content above 4 up to 6 h (P<0.001) protecting pantoprazole from acid degradation resulting in high concentration in the gastric content and stomach tissue. Conclusions: This study substantiates better, faster and prolonged bioavailability of pantoprazole-buffered tablet compared to plain pantoprazole. PMID:21897712

Bigoniya, Papiya; Shukla, A.; Singh, C. S.; Gotiya, P.

2011-01-01

159

Role of bottle feeding in the etiology of hypertrophic pyloric stenosis.  

PubMed

IMPORTANCE Bottle feeding has been implicated in the etiology of hypertrophic pyloric stenosis (HPS). Further data are needed to define the nature of this relationship and the clinical variables that influence it. OBJECTIVE To determine if bottle feeding after birth is associated with the development of HPS in infants. We hypothesized that bottle feeding is associated with an increased risk of HPS and that this risk is modified by other risk factors. DESIGN, SETTING, AND PARTICIPANTS Population-based case-control study of births from January 1, 2003, to December 31, 2009, using Washington State birth certificates linked to hospital discharge data. Cases included all singleton infants born within the study period and subsequently admitted with both a diagnostic code for HPS and a procedure code for pyloromyotomy (n?=?714). Controls were randomly chosen among singleton infants who did not develop HPS and were frequency matched to cases by birth year. EXPOSURE Feeding status (breast vs bottle) was coded on the birth certificate as the type of feeding the infant was receiving at birth discharge. MAIN OUTCOME AND MEASURE Diagnosis of HPS. RESULTS Hypertrophic pyloric stenosis incidence decreased over time, from 14 per 10,000 births in 2003 to 9 per 10,000 in 2009. Simultaneously, breastfeeding prevalence increased from 80% in 2003 to 94% in 2009. Compared with controls, cases were more likely to be bottle feeding after birth (19.5% vs 9.1%). After adjustment, bottle feeding was associated with an increased risk of HPS (odds ratio [OR], 2.31; 95% CI, 1.81-2.95). This association did not differ according to sex or maternal smoking status but was significantly modified by maternal age (<20 years OR, 0.98; 95% CI, 0.51-1.88; ?35 years OR, 6.07; 95% CI, 2.81-13.10) and parity (nulliparous OR, 1.60; 95% CI, 1.07-2.38; multiparous OR, 3.42; 95% CI, 2.23-5.24). CONCLUSIONS AND RELEVANCE Bottle feeding is associated with an increased risk of HPS, and this effect seems to be most important in older and multiparous women. These data suggest that bottle feeding may play a role in HPS etiology, and further investigations may help to elucidate the mechanisms underlying the observed effect modification by age and parity. PMID:24146084

McAteer, Jarod P; Ledbetter, Daniel J; Goldin, Adam B

2013-12-01

160

External anal sphincter defects: correlation between pre-operative anal endosonography and intraoperative findings.  

PubMed

In order to correlate operative findings with external anal sphincter (EAS) defects identified on anal endosonography (AES), 30 faecally incontinent patients undergoing overlapping sphincteroplasty or total pelvic floor repair were investigated by AES before and after surgery. Endosonic findings were correlated with the appearance of EAS at operation. 21 out of 22 defects seen at surgery had been pre-operatively detected by AES (one false negative). Post-operatively the sphincteroplasty was clearly evident on AES. In three cases of failure it showed an extensive hypoechoic area and these patients underwent dynamic graciloplasty. Endosonography is the method of choice for pre-operative imaging of EAS, having an established role in identifying sphincter defects and correlating well with intraoperative findings. Post-operatively, it has the potential to identify breakdown of the previous repair, allowing prompt surgical intervention. Endosonography is helpful in planning the best type of operation following sphincter injury and is useful in auditing the results of surgery. PMID:8785623

Romano, G; Rotondano, G; Esposito, P; Pellecchia, L; Novi, A

1996-01-01

161

Motor function of the opossum sphincter of Oddi.  

PubMed Central

We studied the opossum sphincter of Oddi (SO) because in this species the SO is approximately 3 cm in length and its extraduodenal location permits recording of motor activity with negligible interference from duodenal motor activity. The SO segment of 120 animals was evaluated by one or more of the following: (a) intraluminal manometry; (b) electromyography; (c) common bile duct (CBD) flow monitored by a drop counter; (d) cineradiography of intraductal contrast medium; and (e) histologic examination. SO pull-throughs using an infused catheter of 0.6-mm o.d. invariably showed a high pressure zone (HPZ) of 18 +/- 3 SE mm Hg in the terminal 4-5 mm of the SO segment. This HPZ had a narrow lumen, 0.5-0.7 mm in diam, and prominent circular muscle. The HPZ in the terminal SO had both active and passive components. HPZ with minimal amplitude and a paucity of underlying smooth muscle were present inconstantly at the junction of the SO segment with the CBD and pancreatic duct, respectively. The dominant feature of the SO segment was rhythmic peristaltic contractions that originated in the proximal SO and propagated toward the duodenum. These contractions occurred spontaneously at a rate of 2-8/min, ranged up to 200 mm Hg in magnitude, had a duration of approximately 5 s and were not abolished by tetrodotoxin. Concurrent myoelectric and manometric recordings showed that each phasic contraction was immediately preceded by an electrical spike burst. Simultaneous recordings of cineradiography, CBD inflow of contrast medium, SO manometry, and SO electromyography indicated that rhythmic peristaltic contractions stripped contrast medium from the SO into the duodenum. During SO systole, CBD emptying was transiently interrupted, whereas SO filling occurred during the diastolic interval between SO peristaltic contractions. SO distention increased the frequency of SO peristalsis. We conclude that (a) the dominant feature of the opossum SO is rhythmic peristaltic contractions that originate in the proximal SO and propagate toward the duodenum; (b) these forceful SO peristaltic contractions are myogenic in origin and serve as a peristaltic pump that actively empties the SO segment; (c) CBD outflow occurs passively during SO diastole, but is interrupted transiently during each SO peristaltic contraction; and (d) a short HPZ with active as well as passive components exists in the distal SO segment and acts as a variable resistor to SO outflow. Images PMID:6822661

Toouli, J; Dodds, W J; Honda, R; Sarna, S; Hogan, W J; Komarowski, R A; Linehan, J H; Arndorfer, R C

1983-01-01

162

Abnormalities of the innervation of the urethral striated sphincter musculature in incontinence.  

PubMed

Perineal nerve and transcutaneous spinal cord stimulation have been used to study 17 patients with idiopathic neurogenic faecal incontinence, 12 of whom also had urinary incontinence. Significant increases in spinal, perineal and pudendal nerve motor latencies were demonstrated in all 17 patients. These results suggest that there is damage to the nerves innervating both the urethral and perianal sphincter musculature in these patients, including those with isolated faecal incontinence. There was evidence of both a distal (perineal nerve) and a proximal (sacral root) component to the damage to the nerve supply of the urethral striated sphincter muscle in half of the patients. PMID:6335972

Snooks, S J; Swash, M

1984-08-01

163

The anocavernosal erectile dysfunction syndrome. II Anal fissure and erectile dysfunction.  

PubMed

A previous study has demonstrated that the bulbocavernosus muscle (BCM) is a part of the external anal sphincter (EAS) [Shafik, Arch Androl, 1999]. It aids erection by compressing the penile bulb and the dorsal penile vein, and acts as a 'suction-ejection' pump in the ejaculatory process. Being a part of the EAS, the BCM is assumed to be involved in the different EAS pathologies. A recent study showed that erectile (ED) and ejaculatory dysfunction in 16 men with fecal incontinence (FI) after an anal fistula operation was cured after sphincteroplasty [Shafik, in press]. This article investigates the erectile and ejaculatory status in patients with anal fissure. The study comprised 32 men with acute anal fissure (mean age 36.7 +/- 8.2 s.d. years), 21 with chronic anal fissure (mean age 38.8 +/- 10.3 s.d. years), and 10 healthy volunteers (mean age 35.2 +/- 7.3 s.d. years). Erectile dysfunction occurred in all men with an acute fissure and in 16 of the chronic fissure patients; erection had been normal before fissure occurrence. The volunteers had normal erection. The anal pain radiated to the penis and was exaggerated on erection and penile thrusting. Erectile dysfunction investigations showed normal results. The electromyographic (EMG) activity of the external and internal (IAS) anal sphincters and the BCM as well as anal, penile bulb and cavernosal pressures were recorded. The acute fissures were treated conservatively and chronic ones by internal anal sphincterotomy. The patients were followed for mean periods of 17.3 +/- 3.6 s.d. months. The bulbocavernosus reflex as well as EMG activity of EAS and BCM were normal, while the resting EMG activity of the IAS was increased. The anal pressure in the acute and chronic anal fissure was increased (P < 0.01, P < 0.05, respectively), while the bulbar and cavernosal pressures showed no significant changes. Fissure treatment effected cure of the fissure and the ED in 30/32 of the acute and in 19/21 of the chronic cases. Erectile dysfunction persisted in the four patients in whom the fissures did not heal. In conclusion, a relationship is suggested to exist between anal fissure and ED. The ED occurred in the presence of anal fissure and was normalized with fissure cure. The BCM and anal pain seem to play a role in the etiology of ED associated with anal fissure. PMID:11424966

Shafik, A; El-Sibai, O

2000-10-01

164

Is there a role for pyloric exclusion after severe duodenal trauma?  

PubMed

Duodenal trauma is an infrequent injury, but linked to high morbidity and mortality. Surgical management of duodenal injuries is dictated by: patient's hemodynamic status, injury severity, time of diagnosis, and presence of concomitant injuries. Even though most cases can be treated with primary repair, some experts advocate adjuvant procedures. Pyloric exclusion (PE) has emerged as an ancillary method to protect suture repair in more complex injuries. However, the effectiveness of this procedure is debatable. The "Evidence Based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club performed a critical appraisal of the literature and selected three relevant publications on the indications for PE in duodenal trauma. The first study retrospectively compared 14 cases of duodenal injuries greater than grade II treated by PE, with 15 cases repaired primarily, all of which penetrating. Results showed that PE did not improve outcome. The second study, also retrospective, compared primary repair (34 cases) with PE (16 cases) in blunt and penetrating grade > II duodenal injuries. The authors concluded that PE was not necessary in all cases. The third was a literature review on the management of challenging duodenal traumas. The author of that study concluded that PE is indicated for anastomotic leak management after gastrojejunostomies. In conclusion, the choice of the surgical procedure to treat duodenal injuries should be individualized. Moreover, there is insufficient high quality scientific evidence to support the abandonment of PE in severe duodenal injuries with extensive tissue loss. PMID:25140657

Cruvinel Neto, José; Pereira, Bruno Monteiro Tavares; Ribeiro, Marcelo Augusto Fontenelle; Rizoli, Sandro; Fraga, Gustavo Pereira; Rezende-Neto, João Baptista

2014-01-01

165

Pyloric exclusion in the treatment of severe duodenal injuries: results from the National Trauma Data Bank.  

PubMed

Pyloric exclusion (PEX) has traditionally been used in the management of complicated duodenal injuries to temporarily protect the duodenal repair and prevent septic abdominal complications. We used the American College of Surgeons National Trauma Data Bank (v 5.0) to evaluate adult patients with severe duodenal injuries [American Association for the Surgery of Trauma (AAST) Grade > or = 3] undergoing primary repair only or repair with PEX within 24 hours of admission. Propensity scoring was used to adjust for relevant confounding factors during outcomes comparison. Among 147 patients with severe duodenal injuries, 28 (19.0%) underwent PEX [15.9% (11/69) Grade III vs 34.0% (17/50) Grade IV-V]. Despite similar demographics, PEX was associated with a longer mean hospital stay (32.2 vs 22.2 days, P = 0.003) and was not associated with a mortality benefit. There was a trend toward increased development of septic abdominal complications (intra-abdominal abscess, wound infection, or dehiscence) with PEX that was not statistically significant. After multivariable analysis using propensity score, no statistically significant differences in mortality or occurrence of septic abdominal complications was noted between those patients undergoing primary repair only or PEX. The use of PEX in patients with severe duodenal injuries may contribute to longer hospital stay and confers no survival or outcome benefit. PMID:18942615

DuBose, Joseph J; Inaba, Kenji; Teixeira, Pedro G R; Shiflett, Anthony; Putty, Bradley; Green, D J; Plurad, David; Demetriades, Demetrios

2008-10-01

166

[A case of solitary pelvic kidney with vesicoureteral reflux and neurogenic bladder dysfunction].  

PubMed

A case of solitary pelvic kidney with neurogenic bladder dysfunction with vesicoureteral reflux is presented. The patient was a 15-year-old boy with sacral vertebral dysplasia and hare-lip, and he has been complaining of recurrent fever episodes and urinary incontinence since 11 years old. Renal anomaly was confirmed by DIP, CT and angiography, and grade IV vesicoureteral reflux was demonstrated by voiding cystourethrography. On cystometrography, low compliance bladder which had a 70 ml capacity on first desire to void and 90 ml capacity on maximum desire to void was observed. Electromyography of anal sphincter performed with uroflowmetry revealed no relaxation of external sphincter during voiding. To preserve renal function, antireflux surgery was performed by Cohen's method, and a successful result, that is cessation of reflux and no ureteral obstruction, was achieved. After operation, periodic transcutaneous electrical stimulation were applied to the pudendal nerve, as a result bladder capacity increased to 150 ml and dysuria with incontinence improved. PMID:3495102

Takiuchi, H; Sakurai, T; Tsujimoto, Y; Sugao, H; Nakamura, M

1987-01-01

167

Dilated common duct sign. A potential indicator of a sphincter of Oddi dyskinesia  

SciTech Connect

The cholescintigraphic findings of a Sphincter of Oddi dyskinesia (SOD) in a 45-year-old woman with persistent right upper quadrant pain and biliary colic are reported. After an overnight fast, the patient was injected with 5 mCi of Tc-99 disofenin and .02 micrograms/kg of cholecystokinin (CCK) post maximal gallbladder filling. Pre and postcholescintiscans were obtained and gallbladder ejection fractions determined. The hepatobiliary scan was normal, except for a delay in biliary-bowel transit. The gallbladder responded normally to CCK, however, the Sphincter of Oddi responded abnormally, as there was a paradoxical response to CCK manifested by a marked dilatation of the common bile duct. It was postulate that this dilatation (the dilated common duct sign) was due to an inappropriate response of the smooth muscle of the Sphincter of Oddi (contraction vs relaxation) to CCK and was the cause of this patient's biliary colic. The dilated common duct sign should alert the physician to the possibility of a Sphincter of Oddi dyskinesia.

DeRidder, P.; Fink-Bennett, D.

1984-05-01

168

Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux  

Microsoft Academic Search

Patterns of lower oesophageal sphincter (LOS) function associated with the onset of 644 reflux episodes were recorded and analysed in 67 patients referred for evaluation of gastro-oesophageal reflux (GOR). Patients were studied recumbent, for one hour before and four hours after a standard meal. Transient LOS relaxation was the most prevalent mechanism and overall accounted for 82% of reflux episodes.

J Dent; R H Holloway; J Toouli; W J Dodds

1988-01-01

169

Three-dimensional MRI of the male urethrae with implanted artificial sphincters: initial results  

Microsoft Academic Search

The aim of this study was to develop a method for simultaneous 3D visualization of a new type of artificial urethral sphincter (AUS) and adjacent urinary structures. Serial MR tomograms were acquired from seven men after AUS implantation. 3D reconstruction was performed by thresholding original (positive) and inverted (negative) image intensity and by subsequently fusing positive and negative images. Results

J Deng; M A HALL-CRAGGS; M D CRAGGS; R RICHARDS; S L KNIGHT; A D LINNEY; A R MUNDY

2006-01-01

170

Implantation of autologous bone-marrow-derived cells reconstructs functional urethral sphincters in rabbits.  

PubMed

The purpose of this study was to determine if implantation of autologous bone-marrow-derived cells has the potential to treat stress urinary incontinence caused by intrinsic sphincter deficiency. Bone marrow cells harvested from femurs of New Zealand White rabbits were cultured for 10 days. Seven days before implantation, the urethral sphincters located at the internal urethral orifice were cryo-injured by spraying liquid nitrogen for 15?s. The cultured autologous bone-marrow-derived cells were implanted 7 days after cryo-injury. For controls, cell-free solutions were injected. At 7 and 14 days after implantation, leak point pressures were determined and the urethral sphincters were examined by immunohistochemistry. At 7 and 14 days, the cell-implanted regions contained numerous striated and smooth muscle-like cells expressing myoglobin and smooth muscle actin, respectively. The proportions of myoglobin- and smooth muscle actin-expressing areas in both the 7- and 14-day cell-implanted regions were significantly higher than in controls. By 14 days, these differentiated cells formed contacts with similar cells, creating layered muscle structures. At that time, the leak point pressure of the cell-implanted rabbits was significantly higher than that of the controls. In conclusion, autologous bone-marrow-derived cells can reconstruct functional urethral sphincters. PMID:21091339

Imamura, Tetsuya; Ishizuka, Osamu; Kinebuchi, Yoshiaki; Kurizaki, Yoshiki; Nakayama, Tsuyoshi; Ishikawa, Masakuni; Nishizawa, Osamu

2011-04-01

171

Sphincter (ring muscle) gymnastics for spinal cord injured and spinal cord transected patients  

Microsoft Academic Search

Sphincter gymnastics seem to be able to recruit central pattern generators – networks of neurons that generate motor patterns – through peripheral rhythmic stimuli and to activate them without supraspinal signals. This physical therapy method is thus suitable for treating spinal cord injured and spinal cord transected patients, for it can reach below the injured segment and feed signals into

S. Yom-Tov

2000-01-01

172

Sphincter-preserving surgery after preoperative radiochemotherapy for T3 low rectal cancers  

PubMed Central

The aim of this study was to evaluate the feasibility and the effectiveness of preoperative radiochemotherapy followed by total mesorectal excision (TME) and sphincter-preserving procedures for T3 low rectal cancer. Patients with rectal cancer and T3 tumors located within 1–6 cm of the dentate line received preoperative radiochemotherapy. Concurrent 5-fluorouracil-based radiochemotherapy was used. Radical resection with TME and sphincter-preserving procedures were performed during the six to eight weeks following radiotherapy. Survival was analyzed using the Kaplan-Meier method. The anal function was evaluated using the Wexner score. The clinical response rate was 83.5%, overall downstaging of T classification was 75.3% and pathological complete response was 15.3%. The anastomotic fistula rate was 4.7%. A median follow-up of 30 months showed the local recurrence rate to be 4.7% and the distant metastasis rate to be 5.9%. The three-year overall survival rate was 87%. The degree of anal incontinence as measured using the Wexner score decreased over time, and the anal sphincter function in the majority of patients gradually improved. Preoperative radiochemotherapy was found to improve tumor downstaging, reduces local recurrence, increase the sphincter preservation rate, and is therefore of benefit to patients with T3 low rectal cancer. PMID:22783445

BAI, XUE; LI, SHIYONG; YU, BO; SU, HONG; JIN, WEISEN; CHEN, GANG; DU, JUNFENG; ZUO, FUYI

2012-01-01

173

Sexual Dysfunction and Infertility  

MedlinePLUS

... common type of sexual problem in men is erectile dysfunction, which is when your penis does not become or stay firm. Many medical conditions can cause erectile dysfunction: high blood pressure, diabetes, blood vessel diseases, surgery ...

174

Functional outcome after anal sphincter injury and treatment with mesenchymal stem cells.  

PubMed

This research demonstrates the regenerative effects of mesenchymal stem cells (MSCs) on the injured anal sphincter by comparing anal sphincter pressures following intramuscular and serial intravascular MSC infusion in a rat model of anal sphincter injury. Fifty rats were divided into injury (n = 35) and no injury (NI; n = 15) groups. Each group was further divided into i.m., serial i.v., or no-treatment (n = 5) groups and followed for 5 weeks. The injury consisted of an excision of 25% of the anal sphincter complex. Twenty-four hours after injury, 5 × 10(5) green fluorescent protein-labeled MSCs in 0.2 ml of phosphate-buffered saline (PBS) or PBS alone (sham) were injected into the anal sphincter for i.m. treatment; i.v. and sham i.v. treatments were delivered daily for 6 consecutive days via the tail vein. Anal pressures were recorded before injury and 10 days and 5 weeks after treatment. Ten days after i.m. MSC treatment, resting and peak pressures were significantly increased compared with those in sham i.m. treatment (p < .001). When compared with the NI group, the injury groups had anal pressures that were not significantly different 5 weeks after i.m./i.v. treatment. Both resting and peak pressures were also significantly increased after i.m./i.v. MSC treatment compared with treatment with PBS (p < .001), suggesting recovery. Statistical analysis was done using paired t test with Bonferroni correction. Marked decrease in fibrosis and scar tissue was seen in both MSC-treated groups. Both i.m. and i.v. MSC treatment after injury caused an increase in anal pressures sustained at 5 weeks, although fewer cells were injected i.m. The MSC-treated groups showed less scarring than the PBS-treated groups, with the i.v. infusion group showing the least scarring. PMID:24797828

Salcedo, Levilester; Penn, Marc; Damaser, Margot; Balog, Brian; Zutshi, Massarat

2014-06-01

175

Differential Gene Expression in the Oxyntic and Pyloric Mucosa of the Young Pig  

PubMed Central

The stomach is often considered a single compartment, although morphological differences among specific areas are well known. Oxyntic mucosa (OXY) and pyloric mucosa (PYL, in other species called antral mucosa) are primarily equipped for acid secretion and gastrin production, respectively, while it is not yet clear how the remainder of genes expressed differs in these areas. Here, the differential gene expression between OXY and PYL mucosa was assessed in seven starter pigs. Total RNA expression was analyzed by whole genome Affymetrix Porcine Gene 1.1_ST array strips. Exploratory functional analysis of gene expression values was done by Gene Set Enrichment Analysis, comparing OXY and PYL. Normalized enrichment scores (NESs) were calculated for each gene (statistical significance defined when False Discovery Rate % <25 and P-values of NES<0.05). Expression values were selected for a set of 44 genes and the effect of point of gastric sample was tested by analysis of variance with the procedure for repeated measures. In OXY, HYDROGEN ION TRANSMEMBRANE TRANSPORTER ACTIVITY gene set was the most enriched set compared to PYL, including the two genes for H+/K+-ATPase. Pathways related to mitochondrial activity and feeding behavior were also enriched (primarily cholecystokinin receptors and ghrelin). Aquaporin 4 was the top-ranking gene. In PYL, two gene sets were enriched compared with OXY: LYMPHOCYTE ACTIVATION and LIPID RAFT, a gene set involved in cholesterol-rich microdomains of the plasma membrane. The single most differentially expressed genes were gastrin and secretoglobin 1A, member 1, presumably located in the epithelial line, to inactivate inflammatory mediators. Several genes related to mucosal integrity, immune response, detoxification and epithelium renewal were also enriched in PYL (P<0.05). The data indicate that there is significant differential gene expression between OXY of the young pig and PYL and further functional studies are needed to confirm their physiological importance. PMID:25357124

Colombo, Michela; Priori, Davide; Trevisi, Paolo; Bosi, Paolo

2014-01-01

176

Similarities and differences in the epidemiology of pyloric stenosis and SIDS.  

PubMed

Similar temporal declines in infantile hypertrophic pyloric stenosis (IHPS) and sudden infant death syndrome (SIDS) and other common features have led to hypotheses about a shared etiology. We carried out a population-based study to highlight similarities and differences between IHPS and SIDS. We used vital statistics and hospitalization data on all live births in Washington State, USA (1987-2009). Changes in IHPS and SIDS rates over time were quantified using rate ratios with 95 % confidence intervals (CI). The duration between birth and diagnosis of IHPS or SIDS was examined as a function of gestational age at birth. Logistic regression analysis was used to identify risk factors and quantify adjusted temporal trends (2000-2008). Although both IHPS and SIDS rates declined significantly between 1987 and 2008, the patterns and magnitude of the declines (40 and 74 %, respectively) were different. IHPS and SIDS shared risk factors such as maternal smoking and single parent status but other factors showed qualitatively or and quantitatively different associations. Primiparity was a risk factor for IHPS [odds ratio (OR) 1.24, 95 % CI 1.09-1.41], and a protective factor for SIDS (OR 0.44, 95 % CI 0.36-0.55), while male sex had a stronger association with IHPS (OR 4.51, 95 % CI 3.85-5.28 vs 1.36, 95 % CI 1.13-1.64). Both IHPS and SIDS showed significant inverse associations between gestational age at birth and chronologic age at diagnosis/death. IHPS and SIDS share some epidemiologic features and risk factors but other risk factors have qualitatively or quantitatively different effects and recent temporal trends in the two diseases are dissimilar. PMID:24337864

Lisonkova, Sarka; Joseph, K S

2014-09-01

177

Genetic evidence for the neuronal nitric oxide synthase gene (NOS1) as a susceptibility locus for infantile pyloric stenosis  

SciTech Connect

The etiological role of the gene for neuronal nitric oxide synthase (NOS1) in infantile pyloric stenosis (PS) was investigated by analysis of two intragenic polymorphisms (NOS1a and NOS1b) in 27 families. There was significant overall transmission disequilibrium between PS and NOS1a (P=.006). Consideration of each allele independently revealed a highly significant tendency for allele 7 (210 bp) to be preferentially transmitted to the affected offspring (P=.0006). These observations suggest that NOS1 is a susceptibility locus for PS. 38 refs., 1 fig., 3 tabs.

Chung, E.; Chen, G.; Gardiner, M. [Rayne Inst., London (United Kingdom)] [and others

1996-02-01

178

Bladder Dysfunction in Mice with Experimental Autoimmune Encephalomyelitis  

PubMed Central

The vast majority of patients with multiple sclerosis (MS) develop bladder control problems including urgency to urinate, urinary incontinence, frequency of urination, and retention of urine. Over 60% of MS patients show detrusor-sphincter dyssynergia, an abnormality characterized by obstruction of urinary outflow as a result of discoordinated contraction of the urethral sphincter muscle and the bladder detrusor muscle. In the current study we examined bladder function in female SWXJ mice with different defined levels of neurological impairment following induction of experimental autoimmune encephalomyelitis (EAE), an animal model of central nervous system inflammation widely used in MS research. We found that EAE mice develop profound bladder dysfunction characterized by significantly increased micturition frequencies and significantly decreased urine output per micturition. Moreover, we found that the severity of bladder abnormalities in EAE mice was directly related to the severity of clinical EAE and neurologic disability. Our study is the first to show and characterize micturition abnormalities in EAE mice thereby providing a most useful model system for understanding and treating neurogenic bladder. PMID:18703233

Altuntas, Cengiz Z.; Daneshgari, Firouz; Liu, Guiming; Fabiyi, Adebola; Kavran, Michael; Johnson, Justin M.; Gulen, M. Fatih; Jaini, Ritika; Li, Xiaoxia; Frenkl, Tara L.; Tuohy, Vincent K.

2009-01-01

179

Membrane properties of external urethral and external anal sphincter motoneurones in the cat.  

PubMed Central

1. Intracellular recordings were made from external urethral sphincter (EUS) and external anal sphincter (EAS) motoneurones in the cat spinal cord under pentobarbitone anaesthesia. EUS and EAS motoneurones were located in segments S1 and S2 in the lateral part of the ventral horn corresponding to column Y of Romanes in the cat or group X of Onuf in man. 2. The axonal conduction velocity of sphincter motoneurones, calculated from the latency of the antidromic action potential and the conduction distance, ranged from 16 to 80 ms-1, much slower than that of hindlimb motoneurones. The duration of the spike after-hyperpolarization (AHP) was in a similar range to that of hindlimb motoneurones. The antidromic latency, the duration of the action potential and the duration of the AHP were positively correlated with one another. 3. The input resistance ranged from 2.6 to 9.0 M omega and was positively correlated with the latency of the antidromic spike. The plots of input resistance versus conduction velocity in sphincter motoneurones were distributed around the extrapolated regression line determined for hindlimb motoneurones, indicating that there is a common correlation amongst conduction velocity, input resistance, and size of motoneurones regardless of the muscle type innervated by a motoneurone. 4. The regression line relating AHP duration and input resistance in sphincter motoneurones was quite different from that in hindlimb motoneurones in its slope, indicating that the AHP duration does not depend solely on the size of the motoneurone. 5. The voltage responses to injection of steps of hyperpolarizing current developed a time-dependent depolarizing 'sag' at higher current levels. The delay in onset and the time constant of decay of this depolarizing sag depended upon the peak amplitude of the hyperpolarizing response. The slope resistance in the I-V curve decreased in the hyperpolarizing direction in all neurones examined, indicating the existence of anomalous rectification analogous to the Q current IQ. In some sphincter motoneurones, an increase of slope resistance in the I-V curve was observed when the membrane was further hyperpolarized. 6. The membrane time constant was positively correlated with input resistance, suggesting that motoneurones with high input resistance have high specific membrane resistivity. The dendritic-to-soma conductance ratio (p) and electrotonic length of dendrite (L) were estimated according to Rall's model. p was smaller than that of hindlimb motoneurones, suggesting less developed dendritic arborization. L was similar to that of hindlimb motoneurones. 7. No differences were observed, in any of the above characteristics of motoneurones, between EUS and EAS. PMID:1804967

Sasaki, M

1991-01-01

180

Electromagnetic effects on the biological tissue surrounding a transcutaneous transformer for an artificial anal sphincter system.  

PubMed

This paper reports on the electromagnetic effects on the biological tissue surrounding a transcutaneous transformer for an artificial anal sphincter. The coupling coils and human tissues, including the skin, fat, muscle, liver, and blood, were considered. Specific absorption rate (SAR) and current density were analyzed by a finite-length solenoid model. First, SAR and current density as a function of frequency (10-10(7) Hz) for an emission current of 1.5 A were calculated under different tissue thickness. Then relations between SAR, current density, and five types of tissues under each frequency were deduced. As a result, both the SAR and current density were below the basic restrictions of the International Commission on Non-Ionizing Radiation Protection (ICNIRP). The results show that the analysis of these data is very important for developing the artificial anal sphincter system. PMID:21121071

Zan, Peng; Yang, Bang-hua; Shao, Yong; Yan, Guo-zheng; Liu, Hua

2010-12-01

181

Impact of the new cuff design on reliability of the AS800 artificial urinary sphincter.  

PubMed

The effect of 2 cuff design changes on the mechanical reliability of the current AS800 artificial urinary sphincter was assessed in 126 patients. The surface-treated cuff was introduced in 1983 and the narrow-back design was introduced in 1987. Mean followup for the surface-treated cuff was 40 months, while that for the narrow back was 27.2 months. The incidence of cuff leaks was 1.3%, while the revision rate for clinically significant pressure atrophy, in the absence of a bladder flap urethroplasty, was 2.3%. The overall revision rate for clinically significant pressure atrophy was 9%. No leaks involving the balloon or tubing occurred. The mechanical reliability of the current AS800 artificial urinary sphincter has improved significantly. PMID:1538439

Light, J K; Reynolds, J C

1992-03-01

182

Electromagnetic effects on the biological tissue surrounding a transcutaneous transformer for an artificial anal sphincter system*  

PubMed Central

This paper reports on the electromagnetic effects on the biological tissue surrounding a transcutaneous transformer for an artificial anal sphincter. The coupling coils and human tissues, including the skin, fat, muscle, liver, and blood, were considered. Specific absorption rate (SAR) and current density were analyzed by a finite-length solenoid model. First, SAR and current density as a function of frequency (10–107 Hz) for an emission current of 1.5 A were calculated under different tissue thickness. Then relations between SAR, current density, and five types of tissues under each frequency were deduced. As a result, both the SAR and current density were below the basic restrictions of the International Commission on Non-Ionizing Radiation Protection (ICNIRP). The results show that the analysis of these data is very important for developing the artificial anal sphincter system. PMID:21121071

Zan, Peng; Yang, Bang-hua; Shao, Yong; Yan, Guo-zheng; Liu, Hua

2010-01-01

183

Bowel dysfunction in spinal cord injury: current perspectives.  

PubMed

Permanent disruptions of gastrointestinal function are very common sequel of spinal cord injury (SCI). When motor and sensory nervous integrity are severely affected, neurogenic gastrointestinal dysfunction is an inevitable consequence. Autonomic nervous system miss function has significantly diminished or lost sensory sensations followed with incomplete evacuation of stool from the rectal vault, immobility, and reduced anal sphincter tone all of those predisposing to increased risk of fecal incontinence (FI). The FI is, beside paralysis of extremities, one of the symptoms most profoundly affecting quality of life (QOL) in patients with SCI. We are reviewing current perspectives in management of SCI, discussing some pathophysiology mechanisms which could be addressed and pointing toward actual practical concepts in use for evaluation and improvements necessary to sustain SCI patients QOL. PMID:24549854

Pan, Yuehai; Liu, Bin; Li, Ruijun; Zhang, Zhixin; Lu, Laijin

2014-07-01

184

Do changes in anal sphincter anatomy correlate with anal function in women with a history of vaginal delivery?  

PubMed

Objectives To evaluate anal sphincter anatomy using three-dimensional ultrasonography (3-DAUS) in incontinent women with vaginal delivery, correlate anatomical findings with symptoms of fecal incontinence and determine the effect of vaginal delivery on anal canal anatomy and function. Methods Female with fecal incontinence and vaginal delivery were assessed with Wexner's score, manometry, and 3DAUS. A control group comprising asymptomatic nulliparous was included. Anal pressure, the angle of the defect and length of the external anal sphincter (EAS), the anterior and posterior internal anal sphincter (IAS), the EAS + puborectal and the gap were measured and correlated with score. Results Of the 62, 49 had fecal incontinence and 13 were asymptomatic. Twenty five had EAS defects, 8 had combined EAS+IAS defects, 16 had intact sphincters and continence scores were similar. Subjects with sphincter defects had a shorter anterior EAS, IAS and longer gap than women without defects. Those with a vaginal delivery and intact sphincters had a shorter anterior EAS and longer gap than nulliparous. We found correlations between resting pressure and anterior EAS and IAS length in patients with defects. Conclusions Avaliar a anatomia do esfíncter anal usando ultra-sonografia tridimensional (3D-US) em mulheres incontinentes com parto vaginal, correlacionar os achados anatômicos com sintomas de incontinência fecal e, determinar o efeito do parto vaginal sobre a anatomia e função do canal anal. PMID:25296079

Murad-Regadas, Sthela Maria; Dealcanfreitas, Iris Daiana; Regadas, Francisco Sergio Pinheiro; Rodrigues, Lusmar Veras; Fernandes, Graziela Olivia da Silva; Pereira, Jacyara de Jesus Rosa

2014-09-01

185

Preoperative Chemoradiation for Extraperitoneal T3 Rectal Cancer: Acute Toxicity, Tumor Response, and Sphincter Preservation  

Microsoft Academic Search

Purpose: To evaluate whether or not an intermediate dose of preoperative external radiation therapy intensified by systemic chemotherapy could improve the tumor response, sphincter preservation, and tumor control.Methods and Materials: Between March 1990 and December 1995, 83 consecutive patients with resectable extraperitoneal adenocarcinoma of the rectum were treated with preoperative chemoradiation: bolus i.v. mitomycin C (MMC), 10 mg\\/m2, Day 1

Vincenzo Valentini; Claudio Coco; Numa Cellini; Aurelio Picciocchi; Domenico Genovesi; Giovanna Mantini; Brunella Barbaro; Santa Cogliandolo; Claudio Mattana; Fabrizio Ambesi-Impiombato; Manfredo Tedesco; Maurizio Cosimelli

1998-01-01

186

Recovery of the internal anal sphincter and continence after restorative proctocolectomy.  

PubMed

The internal anal sphincter (IAS) was assessed prospectively using electromyography and manometry in 66 patients (48 men) undergoing restorative proctocolectomy to determine its role in the gradual return of continence. Twenty-nine patients received a J pouch and 37 a W reservoir. Some 38 pouches (J, ten; W, 28) were hand-sewn (mucosal proctectomy with endoanal anastomosis) and 28 (J, 19; W, nine) stapled (end-to-end pouch-anal anastomosis 1 cm above the dentate line). Twelve patients underwent a one-stage procedure (all J pouches), while the remainder had a covering loop ileostomy. Each patient was reassessed immediately after restorative proctocolectomy and again at 7 days, 1 month, 4 months, 9 months and 18 months after pouch formation. Internal sphincter electromyographic activity was greatly reduced after pouch-anal anastomosis (median preoperative frequency 0.51 Hz versus immediate postoperative frequency 0.21 Hz, P < 0.003) and gradually recovered from 4 months after surgery. At 18 months, measurements of IAS function had not fully recovered to preoperative values (median frequency 0.31 Hz; P < 0.03). Resting anal pressures (median preoperative value 99 cmH2O) decreased by over 50 per cent after surgery (median immediate postoperative resting pressure 44 cmH2O) and recovered gradually but incompletely (median pressure at 18 months 63 cmH2O). Eleven patients reported leakage in the follow-up period. The median (range) resting pressure in these patients (54 (40-71) cmH2O) was not significantly different at 9 months from that of those who were continent either before or after operation (59 (46-68) cmH2O). Prolonged recordings in patients with faecal leakage revealed evidence of high-pressure pouch waves that overwhelmed anal sphincter pressures and coincided with leakage. These episodes were most common during sleep, when anal sphincter activity was reduced. PMID:7922067

Farouk, R; Duthie, G S; Bartolo, D C

1994-07-01

187

Group I Secreted PLA2 in the Maintenance of Human Lower Esophageal Sphincter Tone  

Microsoft Academic Search

Background & Aims: In cat spontaneous lower esophageal sphincter (LES), tone is maintained by the activity of group I secreted phospholipase A2 (sPLA2-I) that produces arachidonic acid. Arachidonic acid metabolites activate G proteins linked to phospholipases, producing second messengers and activation of a protein kinase C-dependent pathway to maintain tone. We examined the role of sPLA2-I in the maintenance of

Weibiao Cao; Karen M. Harnett; Jose Behar; Piero Biancani

2000-01-01

188

Lipolytic enzymes of the digestive organs of the crown-of-thorns starfish (Acanthaster planci): comparison of the stomach and pyloric caeca.  

PubMed

1. Stomach and pyloric caeca homogenates from the crown-of-thorns starfish hydrolysed p-nitrophenyl esters, alpha-naphthyl esters, cholesteryl oleate and tributyrin. The pyloric caeca contained the highest activities. 2. The p-nitrophenyl acetate hydrolytic activity eluted at 0.23 M NaCl on ion exchange chromatography while the p-nitrophenyl palmitate hydrolytic activity eluted between 0.2 and 1.0 M NaCl. 3. Polyacrylamide gel zymograms for alpha-naphthyl acetate hydrolytic activity revealed one major band and several minor bands of activity for both tissues. 4. Isoelectric focusing zymograms revealed one major band with a pI = 4.2 for both tissues, with an additional band at pI = 3.5 for pyloric caeca. 5. The pyloric caeca contained twice as much lipid as the stomach. Lipid extracts contained mixtures of steroids and steroid-esters; a cholesterol-like sterol was tentatively identified. PMID:2721155

Brahimi-Horn, M C; Guglielmino, M L; Sparrow, L G; Logan, R I; Moran, P J

1989-01-01

189

The ontogeny of the peptide innervation of the human pylorus, with special reference to understanding the aetiology and pathogenesis of infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

Pyoric stenosis (PS) is a common condition in infancy, which is associated with smooth muscle hypertrophy that results in pyloric outlet obstruction. The author examines the ontogeny of the peptide innervation of the pylorus in fetal tissues and an experimental model in mice and evaluates the histochemical and morphological changes in the pylorus. The data suggest that PS is an

Robin Michael Abel

1996-01-01

190

A study of 11,003 patients with hypertrophic pyloric stenosis and the association between surgeon and hospital volume and outcomes  

Microsoft Academic Search

AimThe availability of large clinical databases allows for careful evaluation of surgical practices, indicators of quality improvement, and cost. We used a large clinical database to compare the effect of surgeon and hospital volume for the care of children with hypertrophic pyloric stenosis (HPS).

Shawn D. Safford; Ricardo Pietrobon; Kristine M. Safford; Henrique Martins; Michael A. Skinner; Henry E. Rice

2005-01-01

191

Highly selective vagotomy plus dilatation of the stenosis compared with truncal vagotomy and drainage in the treatment of pyloric stenosis secondary to duodenal ulceration  

Microsoft Academic Search

Twenty-three consecutive patients with duodenal ulceration complicated by pyloric stenosis who came under the care of one surgeon were treated by highly selective vagotomy (HSV) combined with digital dilatation of the stenosis through a gastrotomy. No form of drainage procedure was used. Thus the antral \\

M J McMahon; M J Greenall; D Johnston; J C Goligher

1976-01-01

192

Sphincter preservation for distal rectal cancer - a goal worth achieving at all costs?  

PubMed Central

To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low rectal cancer was performed, with particular emphasis on sphincter preservation, oncological outcome, functional outcome, morbidity, quality of life, and patient preference. Low anterior resection (AR) is technically feasible in an increasing proportion of patients with low rectal cancer. The cost of sphincter preservation is the risk of morbidity and poor functional outcome in a significant proportion of patients. Transanal and endoscopic surgery are attractive options in selected patients that can provide satisfactory oncological outcomes while avoiding the morbidity and functional sequelae of open total mesorectal excision. In complete responders to neo-adjuvant chemoradiotherapy, a non-operative approach may prove to be an option. Abdominoperineal excision (APE) imposes a permanent stoma and is associated with significant incidence of perineal morbidity but avoids the risk of poor functional outcome following AR. Quality of life following AR and APE is comparable. Given the choice, most patients will choose AR over APE, however patients following APE positively appraise this option. In striving toward sphincter preservation the challenge is not only to achieve the best possible oncological outcome, but also to ensure that patients with low rectal cancer have realistic and accurate expectations of their treatment choice so that the best possible overall outcome can be obtained by each individual. PMID:21412495

Mulsow, Jurgen; Winter, Des C

2011-01-01

193

Sphincter-Preserving Therapy for Treating a Chronic Anal Fissure: Long-term Outcomes  

PubMed Central

Purpose To estimate the risk of recurrent fissure in ano after sphincter preserving treatments. Methods A retrospective case note review, combined with a telephone survey was conducted for all patients treated for a chronic anal fissure between 1998 and 2008. Results Six hundred and twelve patients (303 women: mean age, 39 years; range, 16-86 years) were treated for chronic anal fissure between 1998 and 2008. Topical diltiazem 2% was initially prescribed for 8 weeks. The fissure did not heal in 141 patients. These patients (61 women: mean age, 30 years; range, 15-86 years) were treated with 100 IU botulinum A toxin (Botox) injection combined with a fissurectomy under general anaesthesia. Thirty eight patients suffered a recurrence of their fissure within two years. Thirty-four healed with further medical or sphincter conserving surgical therapy while four required a lateral internal sphincterotomy. Conclusion The vast majority of patients with chronic anal fissure can be treated with sphincter conserving treatments. This may require several interventions before healing can be achieved. Assessment for recurrence after 'conservative' treatments requires a minimum of two-year follow-up. PMID:24999464

Farouk, Ridzuan

2014-01-01

194

The Current Role of the Artificial Urinary Sphincter in Male and Female Urinary Incontinence  

PubMed Central

The evolution of the artificial urinary sphincter has affected the current surgical options for urinary incontinence. With its unique features, the artificial urinary sphincter (AUS) has been an attractive option for the treatment of urinary incontinence regardless of gender. The current paper discusses the indications, contraindications, types of devices, surgical approaches, outcomes, and complications of the AUS in the treatment of both male and female urinary incontinence. A PubMed review of the available literature was performed and articles reporting implantation of artificial urinary sphincters for urinary incontinence in both male and female patients were evaluated. There was a comparable satisfactory continence rate after the implantation of an AUS (59~97% in males vs. 60~92% in females). In comparison, there were some differences in the indications, contraindications, surgical approaches, outcomes, and complications of the AUS implanted for urinary incontinence in male and female patients. AUS implantation is a safe and effective surgical option for the treatment of urinary incontinence of various etiologies. Continuous evolution of the device has made it an attractive option for the treatment of both male and female urinary incontinence. PMID:23658862

Islah, MAR; Cho, Sung Yong

2013-01-01

195

Loneliness and Sexual Dysfunctions.  

ERIC Educational Resources Information Center

Argues that sexual dysfunctions result from early childhood experiences which were originally nonsexual in nature. Contends that psychological difficulties centered around problems of loneliness tend to generate certain sexual dysfunctions. Extends and explores suggestion that genesis of sexual conflicts is in nonsexual infant separation anxiety…

Mijuskovic, Ben

1987-01-01

196

Olfactory dysfunction in dementia.  

PubMed

The natural aging process brings about some inevitable consequences, such as olfactory dysfunction, which is also frequently linked to numerous neurodegenerative disorders. Many age-related dementia, such as Alzheimer's disease, Vascular dementia, Parkinson's disease, and Frontotemporal Dementia often display olfactory dysfunction. Despite the overwhelming evidence of above mentioned facts, the symptomatic relevance and potential clinical and pre-clinical value of olfactory dysfunction remains overlooked by many clinicians and public alike. Olfactory dysfunction has strong practical implications on daily activities and, although not as prominent as in other mammals, olfaction is still an evolutionarily relevant sense involved in human survival (e.g., smelling gas; bad food). In this work, we provide a brief review of current research related to the olfactory dysfunction profiles in different types of dementia. Additionally, we present a compilation of accessible, easy to use olfaction assessment tools; and highlight future directions in terms of improving clinical diagnosis in patient care and research. PMID:25405189

Alves, Jorge; Petrosyan, Agavni; Magalhães, Rosana

2014-11-16

197

Olfactory dysfunction in dementia  

PubMed Central

The natural aging process brings about some inevitable consequences, such as olfactory dysfunction, which is also frequently linked to numerous neurodegenerative disorders. Many age-related dementia, such as Alzheimer’s disease, Vascular dementia, Parkinson’s disease, and Frontotemporal Dementia often display olfactory dysfunction. Despite the overwhelming evidence of above mentioned facts, the symptomatic relevance and potential clinical and pre-clinical value of olfactory dysfunction remains overlooked by many clinicians and public alike. Olfactory dysfunction has strong practical implications on daily activities and, although not as prominent as in other mammals, olfaction is still an evolutionarily relevant sense involved in human survival (e.g., smelling gas; bad food). In this work, we provide a brief review of current research related to the olfactory dysfunction profiles in different types of dementia. Additionally, we present a compilation of accessible, easy to use olfaction assessment tools; and highlight future directions in terms of improving clinical diagnosis in patient care and research.

Alves, Jorge; Petrosyan, Agavni; Magalhaes, Rosana

2014-01-01

198

Erectile dysfunction: management update  

PubMed Central

DRAMATIC ADVANCES IN THE MANAGEMENT of erectile dysfunction have occurred over the past decade. Oral therapy with vasoactive agents has emerged as first-line treatment and has transformed both the manner in which the public views erectile dysfunction and the way health care providers deliver care. Whereas an extensive investigation was previously common in the management of erectile dysfunction, recent treatment guidelines promote a more minimalist, goal-oriented approach. In this article, we review the physiology of erection, and the pathophysiology, diagnosis and clinical management of erectile dysfunction. We also present the existing evidence for the efficacy of 3 phosphodiesterase inhibitors, the most widely used class of agents for erectile dysfunction. PMID:15111479

Fazio, Luke; Brock, Gerald

2004-01-01

199

Condition and pyloric caeca as indicators of food web effects in fish living in metal-contaminated lakes.  

PubMed

Variations in fish condition, pyloric caeca (PC) mass and tissue metal concentrations were examined in two consecutive summers in yellow perch collected along two polymetallic gradients in Canada, Sudbury (ON) and Rouyn-Noranda (QC). The potential of PC mass variations to help interpret food web-mediated changes in condition was also evaluated. The lack of relationships between PC weight and condition, even in reference lakes, indicated that factors other than feeding rate influenced fish condition. Inter-annual variations in fish condition (12-58%), PC weight (14-20%) and tissue metal concentrations (30-550%) were often of greater magnitude than differences between reference and contaminated fish sampled in the same year. The apparent lack of correspondence between feeding rate and condition and the large inter-annual variation in examined metrics highlight the need to better understand the ecological underpinnings that influence metal toxicity in field situations. PMID:19758703

Gauthier, Charles; Campbell, Peter G C; Couture, Patrice

2009-11-01

200

The effects of restraint on uptake of radioactive sulfate in the salivary and gastric secretions of rats with pyloric ligation  

NASA Technical Reports Server (NTRS)

The effects of restraint on the amount of nondialysable radioactive sulfate in the gastric wall and the gastric juice and saliva were investigated. It was found that restraint provokes a significant decrease in salivary radioactive sulfate. This, in turn, is responsible for the decrease of sulfate in the gastric contents observed under these conditions in rats with pyloric ligation. Esophageal ligation associated with this prevents passage of saliva and lowers the amount of radioactive sulfate in the gastric juice. Restraint causes then an increase in the amount of sulfate in the gastric juice, the value observed being very much lower than that of rats with a free esophagus. At the level of the gastric wall, the change observed during restraint does not reach a significant threshold.

Chayvialle, J. A.; Lambert, R.; Ruet, D.

1980-01-01

201

Resolving sphincter of Oddi incontinence for primary duodenal Crohn's disease with strictureplasty  

PubMed Central

INTRODUCTION Crohn's involvement of duodenum is a rare event and may be associated to proteiform symptoms and uncommon pathological aspects which make diagnosis and treatment complex. PRESENTATION OF CASE The peculiar aspect of this case was a suspected duodeno-biliary fistula. The patient (female, 22 years old) was affected by duodenal Crohn's disease. Magnetic resonance imaging showed a dilated common bile duct, whose final part linked to a formation containing fluid, and characterized by filling of the contrast medium in the excretory phase. Abdominal ultrasound showed intra-hepatic and intra-gallbladder aerobilia. At surgery, the duodenum was mobilized showing an inflammatory stricture and a slight dilatation of the common bile duct, with no signs of fistulas. The opened duodenum was anastomized side to side to a transmesocolic loop of the jejunum. After surgery, the general condition of the patient improved. DISCUSSION Only two cases of fistula between a narrow duodenal bulb and the common bile duct have been described in literature and the Authors were not be able to verify the occurrence of a duodenal biliary fistula at surgery. The association between duodenal Crohn's disease and Sphincter of Oddi incontinence is a very rare finding with different etiology: chronic intestinal pseudo-obstruction, common bile duct stones, progressive systemic sclerosis. CONCLUSION The treatment to resolve Sphincter of Oddi incontinence for primary duodenal Crohn's disease is not clear. Strictureplasty could be the treatment of choice, because, resolving the stricture, the duodenal pressure is likely to decrease and the reflux through the incontinent sphincter can be avoided. PMID:23276753

Alemanno, G.; Sturiale, A.; Bellucci, F.; Giudici, F.; Tonelli, F.

2012-01-01

202

Single piece artificial urinary sphincter for secondary incontinence following successful repair of post traumatic urethral injury  

PubMed Central

Post traumatic urethral injury is uncommon in children. The management of this condition is dependent on the severity of injury. Initial suprapubic cystostomy with delayed repair is the conventional treatment. Successful reconstruction of urethral injury may be followed by urethral stricture, incontinence, impotence, and retrograde ejaculation. Successful repair of post traumatic urethral injury followed by secondary incontinence in children has not been well addressed in literature. We report the management of one such child, with satisfactory outcome with implantation of a new model of single piece artificial urinary sphincter in the bulbar urethra by perineal approach. PMID:24347870

Kandpal, D. K.; Rawat, S. K.; Kanwar, S.; Baruha, A.; Chowdhary, S. K.

2013-01-01

203

Pelvic Floor Dysfunction  

MedlinePLUS

... pelvic floor dysfunction? For most people, having a bowel movement is a seemingly automatic function. For some individuals, ... incomplete emptying of the rectum when having a bowel movement. Incomplete emptying may result in the individual feeling ...

204

Sexual Dysfunction Following Vulvectomy  

Microsoft Academic Search

Objective. This is a pilot study to evaluate sexual dysfunction in women after vulvectomy.Methods. An 88-question survey was used to assess body image and the DSM IV criteria for sexual dysfunction on women who had undergone vulvectomy.Results. Forty-seven women agreed to participate in the study and 41 women (87%) returned the survey. There was a significant alteration of body image

Michael S. Green; R. Wendel Naumann; Mollie Elliot; James B. Hall; Robert V. Higgins; Jared H. Grigsby

2000-01-01

205

Randomized, Clinical Trial of Bowel Confinement vs. Laxative Use After Primary Repair of a Third-Degree Obstetric Anal Sphincter Tear  

Microsoft Academic Search

PURPOSE: Third-degree tears are generally managed by primary anal sphincter repair. Postoperatively, some physicians recommend laxative use, whereas others favor bowel confinement after anorectal reconstructive surgery. This randomized trial was designed to compare a laxative regimen with a constipating regimen in early postoperative management after primary obstetric anal sphincter repair. METHODS: A total of 105 females were randomized after primary

Rhona Mahony; Michael Behan; Colm O’Herlihy; P. Ronan O’Connell

2004-01-01

206

A comparison of common bile duct pressures after botulinum toxin injection into the sphincter of Oddi versus biliary stenting in a canine model  

Microsoft Academic Search

Background: Botulinum toxin A (Botox) functionally paralyzes the sphincter of Oddi in both animals and humans, resulting in reduced pressures. No study, however, has specifically addressed common bile duct (CBD) pressures after Botox injection into the sphincter of Oddi with regard to treating biliary leaks and fistulae. The goals of this present study are to compare, versus biliary stenting, the

Jeffrey M Marks; Andrew L Bower; Marlene Goormastic; Janis L Malycky; Jeffrey L Ponsky

2001-01-01

207

Restoration of continence following rectopexy for rectal prolapse and recovery of the internal anal sphincter electromyogram.  

PubMed

Twenty-two patients with full-thickness rectal prolapse underwent ambulatory fine wire electromyography of the internal and sphincter (IAS), external and sphincter and puborectalis, together with anorectal manometry, using a computerized system. Examinations were performed both before and 3 to 4 months after rectopexy. The median (interquartile range (i.q.r.)) preoperative IAS electromyogram (EMG) frequency was 0.18 (0.05-0.31) Hz and the median (i.q.r.) preoperative resting anal pressure was 28 (15-64) cmH2O. An improvement in the IAS EMG frequency, median (i.q.r.) 0.29 (0.19-0.38) Hz (P less than 0.03), and resting anal pressure, median (i.q.r.) 41 (20-72) cmH2O (P less than 0.05), was recorded after operation, but these variables remained significantly lower than those found in normal controls: median (i.q.r.) IAS EMG frequency 0.44 (0.36-0.48) Hz and median (i.q.r.) resting anal pressure 92 (74-98) cmH2O. We suggest that repair of the prolapse allows the IAS to recover by removing the cause of persistent rectoanal inhibition. PMID:1596729

Farouk, R; Duthie, G S; Bartolo, D C; MacGregor, A B

1992-05-01

208

[Intermittent electromechanical dissociation of the internal anal sphincter in idiopathic fecal incontinence].  

PubMed

Ten patients with median age of 51 years (range 24-75; 9 female) presenting idiopathic faecal incontinence and twelve normal subjects with median age of 34 years (range 25-71; 5 female) underwent fine wire anal sphincter electromyography and anal manometry. The results were analysed using non-parametric methods of statistical analysis. The median IAS EMG was 0.30 Hz (range 0.18-0.38), in incontinent and 0.48 Hz (range 0.31-0.55) in controls; p. < 0.01. Ambulatory resting pressures were a median of 66 cmH2O (range 49-83 cmH2O), for the incontinent and 82 cmH2O (range 66-120) for controls; p < 0.04. IAS EMG frequency correlated with resting anal pressures in both groups (p < 0.003). IAS EMG silence not attributable to electrode movement or to the recto-anal inhibitory reflex, lasting 0.5-4 minutes, occurred in all but two of the incontinent patients. No recruitment of the external sphincter or puborectalis muscle was noted during these episodes. Such electromechanical dissociation was not seen in the control group. PMID:8481284

Gammarota, F V; Farouk, R; Duthie, G S; Bartolo, D C

1993-01-01

209

Effect of nitrovasodilators on the rhythmic contractions of guinea-pig isolated sphincter of Oddi.  

PubMed

The effects of amyl nitrite (CAS 8017-89-8) isosorbide dinitrate (CAS 87-33-2) and sodium nitroprusside (CAS 14402-89-2), on the acetylcholine-induced tachyrhythmia (greater than 9 waves/min) were investigated in the isolated guinea-pig sphincter of Oddi. Acetylcholine (10(-3) mol/l) produced an initial rapid rise in tension, the peak being followed by a gradual decrease associated with the initiation of the peristaltic waves. Nitrovasodilators significantly decreased the initial response to acetylcholine. Methylene blue (5 x 10(-5) mol/l), a soluble guanylate cyclase inhibitor, increased the tonic response to acetylcholine and reversed the inhibition caused by nitrovasodilators. The frequency and amplitude of peristaltic waves were decreased by nitrovasodilators. Methylene blue significantly increased both the frequency and amplitude of peristaltic waves, however, it did not reverse the inhibition caused by nitrovasodilators tested. Results suggest that nitrates decrease the acetylcholine-induced contraction and peristaltism of isolated guinea-pig sphincter of Oddi and NO released by acetylcholine may partially suppress its own tonic contractile response. PMID:8573227

Göçer, F; Yari?, E; Tuncer, M; Kayaalp, S O

1995-07-01

210

Early effect of external beam radiation therapy on the anal sphincter: a study using anal manometry and transrectal ultrasound.  

PubMed

The early of pelvic irradiation on the anal sphincter has not been previously investigated. This study prospectively evaluated the acute effect of preoperative radiation on anal function. Twenty patients with rectal carcinoma received 4,500 cGy of preoperative external beam radiation. The field of radiation included the sphincter in 10 patients and was delivered above the anorectal ring in 10 patients. Anal manometry and transrectal ultrasound were performed before and four weeks after radiotherapy. No significant difference in mean maximal squeeze or resting pressure was found after radiation therapy. An increase in mean minimal sensory threshold was significant. Histologic examination revealed minimal radiation changes at the distal margin in 8 of 10 patients who underwent low anterior resection and in 1 of 3 patients who underwent abdominoperineal resection. We conclude that preoperative radiation therapy has minimal immediate effect on the anal sphincter and is not a major contributing factor to postoperative incontinence in patients after sphincter-saving operations for rectal cancer. PMID:1643999

Birnbaum, E H; Dreznik, Z; Myerson, R J; Lacey, D L; Fry, R D; Kodner, I J; Fleshman, J W

1992-08-01

211

Effect of atropine on the frequency of reflux and transient lower esophageal sphincter relaxation in normal subjects  

Microsoft Academic Search

Background & Aims Low basal lower esophageal sphincter (LES) pressure is believed to be an important mechanism of reflux. The effects of atropine on the frequency and mechanisms of gastroesophageal reflux under the experimental conditions of a low basal LES pressure in 13 normal subjects were studied. Methods LES pressure, esophageal pressures, esophageal pH, and crural diaphragm electromyogram were recorded

Ravinder K. Mittal; Richard Holloway; John Dent

1995-01-01

212

Motor evoked potentials recorded from external anal sphincter by cortical and lumbo-sacral magnetic stimulation: Normative data  

Microsoft Academic Search

Electrophysiological activation of the motor pathways can be obtained by electrical or magnetic stimulation. The latter has the great advantage of being painful and able to stimulate deeply situated nervous structures. Only a few reports describe responses obtained from pelvic floor muscles and external anal sphincter (EAS) by transcranial and lumbo-sacral magnetic stimulation. Our purpose is to present normative data

G Pelliccioni; O Scarpino; V Piloni

1997-01-01

213

Human amniotic fluid stem cell injection therapy for urethral sphincter regeneration in an animal model  

PubMed Central

Background Stem cell injection therapies have been proposed to overcome the limited efficacy and adverse reactions of bulking agents. However, most have significant limitations, including painful procurement, requirement for anesthesia, donor site infection and a frequently low cell yield. Recently, human amniotic fluid stem cells (hAFSCs) have been proposed as an ideal cell therapy source. In this study, we investigated whether periurethral injection of hAFSCs can restore urethral sphincter competency in a mouse model. Methods Amniotic fluids were collected and harvested cells were analyzed for stem cell characteristics and in vitro myogenic differentiation potency. Mice underwent bilateral pudendal nerve transection to generate a stress urinary incontinence (SUI) model and received either periurethral injection of hAFSCs, periurethral injection of Plasma-Lyte (control group), or underwent a sham (normal control group). For in vivo cell tracking, cells were labeled with silica-coated magnetic nanoparticles containing rhodamine B isothiocyanate (MNPs@SiO2 (RITC)) and were injected into the urethral sphincter region (n = 9). Signals were detected by optical imaging. Leak point pressure and closing pressure were recorded serially after injection. Tumorigenicity of hAFSCs was evaluated by implanting hAFSCs into the subcapsular space of the kidney, followed two weeks later by retrieval and histologic analysis. Results Flow activated cell sorting showed that hAFSCs expressed mesenchymal stem cell (MSC) markers, but no hematopoietic stem cell markers. Induction of myogenic differentiation in the hAFSCs resulted in expression of PAX7 and MYOD at Day 3, and DYSTROPHIN at Day 7. The nanoparticle-labeled hAFSCs could be tracked in vivo with optical imaging for up to 10 days after injection. Four weeks after injection, the mean LPP and CP were significantly increased in the hAFSC-injected group compared with the control group. Nerve regeneration and neuromuscular junction formation of injected hAFSCs in vivo was confirmed with expression of neuronal markers and acetylcholine receptor. Injection of hAFSCs caused no in vivo host CD8 lymphocyte aggregation or tumor formation. Conclusions hAFSCs displayed MSC characteristics and could differentiate into cells of myogenic lineage. Periurethral injection of hAFSCs into an SUI animal model restored the urethral sphincter to apparently normal histology and function, in absence of immunogenicity and tumorigenicity. PMID:22906045

2012-01-01

214

ED: Non-Surgical Management (Erectile Dysfunction)  

MedlinePLUS

... Management Hormone Health Network's Erectile Dysfunction Fact Sheet Urology Care Foundation Patient Brochure: Sexual Health Series: Erectile Dysfunction Urology Care Foundation Fact Sheets: Erectile Dysfunction Diagnosing Erectile ...

215

Reversal of lower esophageal sphincter hypotension and esophageal aperistalsis after treatment for hypothyroidism  

SciTech Connect

A 65-year-old woman suffered from both chronic gastroesophageal reflux, which was complicated by columnar metaplasia (Barrett's epithelium), and profound hypothyroidism. An esophageal motility tracing showed absence of peristalsis in the lower esophagus and the lower esophageal sphincter (LES) could not be identified. Thyroid replacement therapy, in conjunction with antacid and cimetidine treatment, was associated not only with improvement in the gastroesophageal reflux symptoms, but also with a return of esophageal peristalsis and LES pressure to normal. To support our clinical observations, we rendered four cats hypothyroid with /sup 131/I and documented a fall in LES pressure. We propose that abnormal smooth-muscle function of the esophagus may be another manifestation of the gastrointestinal motility disturbances which are associated with hypothyroidism.

Eastwood, G.L.; Braverman, L.E.; White, E.M.; Vander Salm, T.J.

1982-08-01

216

Anal sphincter structure and function relationships in aging and fecal incontinence  

PubMed Central

Objective To determine the effect of aging and continence status on the structure and function of the external (EAS) and internal (IAS) anal sphincters Study Design Young (YC) and older (OC) continent women were compared to older women with fecal incontinence (OI). Patients completed the FIQOL and FISI and underwent anorectal manometry and transanal ultrasound. Results 9 YC, 9 OC, and 8 OI women participated. Aging was associated with a thickening of the IAS, while only women with FI had decreased resting pressures. Older incontinent women had a thinner EAS, decreased maximum squeeze pressures, and were hypersensitive to rectal distention with decreased tolerable rectal volumes and urge to defecate at lower volumes. Conclusion Thickening of the IAS occurs with aging. Thinning of the EAS and a corresponding drop in squeeze pressure correlated with FI, but not with aging. Rectal hypersensitivity was associated with FI rather than aging and may play a role in the mechanism of FI. PMID:19136096

Lewicky-Gaupp, Christina; Hamilton, Quinn; Ashton-Miller, James; Huebner, Markus; DeLancey, John O.L.; Fenner, Dee E.

2011-01-01

217

Perceptual-Motor Dysfunction.  

ERIC Educational Resources Information Center

Discussed are theoretical and treatment aspects of perceptual motor dysfunction and rehabilitation in 4- to 12-year-old academically failing children involved in a 3-year investigation at the University of Kansas. The program is said to stress increasing the amount of stimulation received by sensory receptors of the vestibular, reflex, and haptic…

Pyfer, Jean L.

218

Adipocytokines in Thyroid Dysfunction  

PubMed Central

Adipocytokines are important mediators of interorgan crosstalk in metabolic regulation. Thyroid diseases have effects on metabolism and inflammation. The mechanism of these effects is not clear. Recently, there are several reports suggesting this interrelation between adipocytokines and thyroid dysfunction. In this review, we summarize this relation according to the literature. PMID:24049662

Aydogan, Berna Imge; Sahin, Mustafa

2013-01-01

219

Outcome of repair of obstetric anal sphincter injuries after three years  

PubMed Central

Objective To prospectively assess change in bowel symptoms and quality of life (QoL) approximately 3 years after primary repair of obstetric anal sphincter injuries (OASIS). Methods Between July 2002 and December 2007 women who attended the perineal clinic at Croydon University Hospital, UK, 9 weeks following primary repair of OASIS were asked to complete the Manchester Health Questionnaire and a questionnaire to obtain a St Mark incontinence score. All women had endoanal scans at this visit. In June 2008 all women were asked to complete the questionnaires again. Results Of 344 patients who responded to the questionnaires and were included in the analysis, long-term symptoms of fecal urgency, flatus incontinence, and fecal incontinence occurred in 62 (18.0%), 52 (15.1%), and 36 (10.5%), respectively. Overall, there was a significant improvement in fecal urgency (P < 0.001) and flatus incontinence (P < 0.001) from 9 weeks to 3 years. Of 31 women with fecal incontinence symptoms at early follow-up, 28 were asymptomatic at 3 years. However, 33 women developed de novo symptoms. The only predictors of fecal incontinence at 3 years were fecal urgency at 9 weeks (OR 4.65; 95% CI, 1.38–15.70) and a higher St Mark score (OR 1.40; 95% CI, 1.09–1.80). Conclusion Following primary repair of OASIS, the majority of symptoms and QoL significantly improve, unless there is a persistent anal sphincter defect. This highlights the importance of adequate repair. PMID:25097141

Reid, Annette J.; Beggs, Andrew D.; Sultan, Abdul H.; Roos, Anne-Marie; Thakar, Ranee

2014-01-01

220

The Treatment of Erectile Dysfunction  

Microsoft Academic Search

Erectile dysfunction (ED) is a common age-related sexual dysfunction. It can be a treatment challenge for the therapist because it is notoriously associated with psychological, physical and relational risk factors. Typically, ED adversely impacts the man's self esteem, partner satisfaction and the couple's intimate relationship. This sexual dysfunction is often co-morbid with physical risk factors such as diabetes and cardiovascular

Nancy Gambescia; Shelley Kara Sendak

2009-01-01

221

Anorectal dysfunction in patients with urologic disturbance due to multiple sclerosis.  

PubMed

Anorectal function was evaluated in 11 patients with voiding dysfunction due to multiple sclerosis. In six patients with constipation, three also had symptoms of obstructed defecation and one patient was incontinent due to stercoral diarrhea. One patient was only fecal incontinent and one patient had obstructed defecation as the only symptom. Three patients had no anorectal symptoms. Anal manometry in the women compared with a control group revealed significant lower anal resting and squeeze pressures, although no significant difference of rectal sensation to distention with air was found. Pudendal nerve terminal latencies were obtained in seven patients and were all normal. In four patients latency could not be demonstrated due to poor contraction of the sphincter on stimulation of the pudendal nerve. Two of these patients were incontinent and two had both constipation and obstructed defecation. It is concluded that patients with voiding symptoms due to multiple sclerosis often reveal anorectal symptoms or motility disorders. Although anal sphincter function is reduced, fecal incontinence is not prevalent in this group. The reason for this lies probably in the fact that many of the patients are constipated, thus securing fecal continence. PMID:1993411

Sørensen, M; Lorentzen, M; Petersen, J; Christiansen, J

1991-02-01

222

Epidemiology of Erectile Dysfunction  

Microsoft Academic Search

Erectile dysfunction (ED) is a highly prevalent condition among men all over world. It has a significant negative impact on\\u000a the quality of life of the patients and partners. Its prevalence and incidence are associated with aging as well as important\\u000a comorbidities, such as cardiovascular disease, diabetes, metabolic syndrome, hyperlipidemia, depression, pelvic surgery, side\\u000a effects of medications, neurological disorders, trauma,

Ridwan Shabsigh

223

Diabetes and Cardiac Dysfunction  

Microsoft Academic Search

\\u000a Type 2 diabetes is associated with a marked increase in cardiovascular disease. This review summarizes some of the experimental\\u000a evidence supporting the existence of a diabetic cardiomyopathy, defined as ventricular dysfunction in the absence of coronary\\u000a artery disease, in three rodent models of type 2 diabetes produced by leptin receptor mutations: diabetic db\\/db mice, diabetic ZDF fa\\/fa rats, and corpulent]CK:LA-cp\\/cp

David L. Severson; Ellen Aasum; Darrell D. Belke; Terje S. Larsen; Lisa M. Semeniuk; Yakhin Shimoni

224

Outcomes of Sphincter-Saving Operation for Rectal Cancer without Protective Stoma and Pelvic Drain, and Risk Factors for Anastomotic Leakage  

Microsoft Academic Search

Background\\/Aims: To evaluate the outcomes of sphincter-saving operation for rectal cancer without protective stoma and pelvic drain and to determine factors influencing anastomotic leakage. Methods: We investigated 170 patients undergoing elective sphincter-saving operation without protective stoma and pelvic drain during 2003–2006 in a single institution. Early postoperative outcomes were evaluated. 17 independent patient-, tumor-, and treatment-related variables were analyzed by

Varut Lohsiriwat; Darin Lohsiriwat; Wiroon Boonnuch; Vitoon Chinswangwatanakul; Thawatchai Akaraviputh; Woramin Riansuwan; Narong Lert-akyamanee

2008-01-01

225

Upper esophageal sphincter abnormalities are strongly predictive of treatment response in patients with achalasia  

PubMed Central

AIM: To investigate the relationship between upper esophageal sphincter abnormalities achalasia treatment METHODS: We performed a retrospective study of 41 consecutive patients referred for high resolution esophageal manometry with a final manometric diagnosis of achalasia. Patients were sub-divided by presence or absence of Upper esophageal sphincter (UES) abnormality, and clinical and manometric profiles were compared. Correlation between UES abnormality and sub-type (i.e., hypertensive, hypotensive or impaired relaxation) and a number of variables, including qualitative treatment response, achalasia sub-type, co-morbid medical illness, psychiatric illness, surgical history, dominant presenting symptom, treatment type, age and gender were also evaluated. RESULTS: Among all 41 patients, 24 (58.54%) had a UES abnormality present. There were no significant differences between the groups in terms of age, gender or any other clinical or demographic profiles. Among those with UES abnormalities, the majority were either hypertensive (41.67%) or had impaired relaxation (37.5%) as compared to hypotensive (20.83%), although this did not reach statistical significance (P = 0.42). There was no specific association between treatment response and treatment type received; however, there was a significant association between UES abnormalities and treatment response. In patients with achalasia and concomitant UES abnormalities, 87.5% had poor treatment response, while only 12.5% had favorable response. In contrast, in patients with achalasia and no UES abnormalities, the majority (78.57%) had good treatment response, as compared to 21.43% with poor treatment response (P = 0.0001). After controlling for achalasia sub-type, those with UES abnormality had 26 times greater odds of poor treatment response than those with no UES abnormality (P = 0.009). Similarly, after controlling for treatment type, those with UES abnormality had 13.9 times greater odds of poor treatment response compared to those with no UES abnormality (P = 0.017). CONCLUSION: The presence of UES abnormalities in patients with achalasia significantly predicted poorer treatment response as compared to those with normal UES function.

Mathews, Simon C; Ciarleglio, Maria; Chavez, Yamile Haito; Clarke, John O; Stein, Ellen; Chander Roland, Bani

2014-01-01

226

Clinical results and manometric studies after rectal flap advancement for infra-levator trans-sphincteric fistula-in-ano.  

PubMed

Eleven patients with infra-levator trans-sphincteric fistula-in-ano underwent fistula excision with rectal flap advancement. The clinical results were assessed by interview and the physiological function determined by ano-rectal manometry. Nine patients underwent paired studies before and 5 (range 2 to 6) months after operation. Median maximum resting anal pressure was 84 (48-135) cm water before operation and 76 (29-139) cm water after operation (P = N.S.). Median maximum squeeze pressure was 112 (64-290) cm water before operation and 88 (44-316) cm water after operation (P = N.S.). The median sphincter length was preserved after operation. There was one clinical failure following the development of an abscess under the flap. All patients are continent and there have been no recurrences. We conclude that rectal flap advancement is an acceptable way to cure more complex fistula-in-ano. Good functional results are achieved by maintaining anal sphincter function together with preservation of the integrity of the anal margin. PMID:8568401

Lewis, W G; Finan, P J; Holdsworth, P J; Sagar, P M; Stephenson, B M

1995-01-01

227

Esophageal smooth muscle dysfunction in oculopharyngeal muscular dystrophy.  

PubMed

Oculopharyngeal muscular dystrophy (OPMD) is a rare genetic disorder with late-onset progressive myopathy affecting mainly head and neck striated muscles. It is more common in certain ethnic communities. Dysphagia was usually attributed to the malfunction of striated pharyngeal muscles. We studied a group of Bukharan immigrants affected by this disorder (N = 13). Esophageal studies, including endoscopy, manometry, and scintigraphic emptying were performed. Very low pharyngeal pressures were measured. Upper esophageal pressures (UEP) were in the normal range in eight patients, and above normal in three patients. Four also had low lower esophageal sphincter pressure. Esophageal body peristaltic activity was grossly impaired in all patients: mainly nonpropulsive, simultaneous, retrograde, and failed activity was recorded. Marked retention of isotopic material was demonstrated in all patients studied, usually in the middle and lower parts of the body, ranging from 17 to 100% retention. The dysphagia in OPMD is due not only to dysfunction of pharyngeal and upper esophageal striated muscle, but also has a significant smooth muscle component. PMID:8689911

Tiomny, E; Khilkevic, O; Korczyn, A D; Kimmel, R; Hallak, A; Baron, J; Blumen, S; Asherov, A; Gilat, T

1996-07-01

228

Management of ejaculatory dysfunction.  

PubMed

Ejaculatory dysfunction is a common complaint and is often associated with a reduced quality of life for sufferer and partner. The spectrum of ejaculatory dysfunction extends from premature ejaculation (PE) to delayed ejaculation (DE) and anejaculation. Over the past 20-30 years, the PE treatment paradigm, previously limited to behavioural psychotherapy, has expanded to include drug treatment. Multiple well-controlled, evidence-based studies have demonstrated the efficacy and safety of selective serotonin re-uptake inhibitors in delaying ejaculation, confirming their role as first-line agents for the treatment of lifelong and acquired PE. More recently, there has been increased attention to the psychosocial consequences of PE, its epidemiology, its aetiology and its pathophysiology by both clinicians and the pharmaceutical industry. DE and anejaculation are probably the least common, least studied and least understood of the male sexual dysfunctions. However, their impact is significant as they may result in a lack of sexual fulfilment for both the man and his partner, an effect further compounded when procreation is among the couple's goals of sexual intercourse. The causes of DE, anejaculation and anorgasmia are manifold. Numerous psychotherapeutic treatments are described for the management of delayed or anejaculation. Although some appear to be effective, none has been properly evaluated in large-scale samples. Treatment of DE or anejaculation with pharmacotherapy has met with limited success. No drugs have been approved by regulatory agencies for this purpose, and most drugs that have been identified for potential use have limited efficacy, impart significant side-effects or are yet considered experimental in nature. PMID:24528812

McMahon, C G

2014-02-01

229

A new reliable reference gene UBA52 for quantitative real-time polymerase chain reaction studies in pyloric cecal tissues of the starfish Asterias rubens.  

PubMed

The starfish Asterias rubens is one of the most abundant echinoderm species in the White, Barents, North, and Baltic Seas. This species is an important component of marine ecosystems and a model object for certain biological studies, in particular those requiring quantitative estimation of gene expression. As a rule, expression at the transcriptional level is estimated by real-time qPCR using the ??Ct method, which allows the comparison of the copy number of target gene transcripts in samples with unknown mRNA/cDNA concentration. Application of this method requires normalization of the results relative to genes with stable expression levels (reference genes). The identification of reference genes is still a challenging task since data of this kind are missing for certain taxa, whereas the use of "standard" endogenous control genes without additional tests might lead to erroneous conclusions. We performed a preliminary analysis of the expression of many housekeeping genes in the pyloric ceca of A. rubens by high-throughput sequencing under normal and heat shock conditions. For one of them, the ubiquitin gene UBA52, low variation of expression (not greater than 2-fold) was shown using real-time qPCR. Tissues of pyloric ceca of normal adults and underyearlings and of adults after heat shock were used. The data obtained suggest that the UBA52 gene may be used as reference for normalization of gene expression at the mRNA level in the starfish A. rubens and probably in closely related species. PMID:24938608

Sadritdinova, A F; Dmitriev, A A; Snezhkina, A V; Belenikin, M S; Krasnov, G S; Manylov, O G; Kudryavtsev, A A; Melnikova, N V; Speranskaya, A S; Darii, M V; Lakunina, V A; Uroshlev, L A; Smurov, A O; Stepanov, O A; Kudryavtseva, A V

2014-01-01

230

Reappraisal of the Immunophenotype of Pancreatic Intraductal Papillary Mucinous Neoplasms (IPMNs)--Gastric Pyloric and Small Intestinal Immunophenotype Expression in Gastric and Intestinal Type IPMNs--  

PubMed Central

Pancreatic intraductal papillary mucinous neoplasms (IPMNs) are mucin-producing neoplasms of the main and/or branch pancreatic ducts. To assess differences between various IPMN subtypes, immunohistochemical markers of gastric surface mucous cells (MUC5AC), gastric gland mucous cells (MUC6 and GlcNAc?1?4Gal??R), gastric pyloric and duodenal epithelial cells (PDX1), intestinal cells (MUC2 and CDX2), small intestinal cells (CPS1) and large intestinal cells (SATB2) were evaluated in 33 surgically treated IPMNs. MUC2 expression classified IPMNs into gastric (n=17), intestinal (n=8) and mixed gastric and intestinal type (collision=7, composite=1). No differences in age or sex were observed among these types. MUC5AC and PDX1 were expressed in all IPMNs. MUC6 expression was higher in gastric and mixed types than in intestinal type. GlcNAc?1?4Gal??R was detected in gastric and mixed type, but not in intestinal type. MUC2 and CDX2 expression were higher in intestinal type than gastric and mixed type. CPS1 expression was higher in intestinal type than gastric type. SATB2 was not observed in any IPMNs. Frequent abrupt transition between the two IPMN types in mixed-type IPMNs was observed. Gastric pyloric and small intestinal differentiation are characteristic of gastric and intestinal type IPMN, respectively, and these two IPMN types may have distinct pathogenesis.

Kobayashi, Mikiko; Fujinaga, Yasunari; Ota, Hiroyoshi

2014-01-01

231

Involvement of pituitary adenylate cyclase-activating peptide in opossum internal anal sphincter relaxation.  

PubMed

Despite its widespread distribution and significance in the gut, the role of pituitary adenylate cyclase-activating peptide (PACAP) in internal anal sphincter (IAS) relaxation has not been examined. This study examined the role of PACAP in nonadrenergic noncholinergic (NANC) nerve-mediated relaxation of IAS smooth muscle. Circular smooth muscle strips from the opossum IAS were prepared for measurement of isometric tension. The influence of PACAP and vasoactive intestinal peptide (VIP) antagonists and tachyphylaxis on the neurally mediated IAS relaxation was examined either separately or in combination. The release of these neuropeptides in response to NANC nerve stimulation before and after the nitric oxide (NO) synthase inhibitor Nomega-nitro-L-arginine and NO was also investigated. Both PACAP and VIP antagonists caused significant attenuation of IAS relaxation by NANC nerve stimulation. The combination of the antagonists, however, did not have an additive effect on IAS relaxation. VIP tachyphylaxis caused significant suppression of IAS relaxation by NANC nerve stimulation. PACAP and VIP were found to be released by NANC nerve stimulation and exogenous NO. The data suggest the involvement of PACAP in IAS relaxation primarily by the activation of PACAP1/VIP receptor and lack of its independent role in the relaxation. Furthermore, NO may regulate the presynaptic release of PACAP and VIP. PMID:9756508

Chakder, S; Rattan, S

1998-10-01

232

Mechanism of internal anal sphincter smooth muscle relaxation by phorbol 12,13-dibutyrate.  

PubMed

We investigated the mechanism of the inhibitory action of phorbol 12,13-dibutyrate (PDBu), one of the typical protein kinase C (PKC) activators, in in vitro smooth muscle strips and in isolated smooth muscle cells of the opossum internal anal sphincter (IAS). The inhibitory action of PDBu on IAS smooth muscle (observed in the presence of guanethidine + atropine) was partly attenuated by tetrodotoxin, suggesting that a part of the inhibitory action of PDBu is via the nonadrenergic, noncholinergic neurons. A major part of the action of PDBu in IAS smooth muscle was, however, via its direct action at the smooth muscle cells, accompanied by a decrease in free intracellular Ca(2+) concentration ([Ca(2+)](i)) and inhibition of PKC translocation. PDBu-induced IAS smooth muscle relaxation was unaffected by agents that block Ca(2+) mobilization and Na+-K+-ATPase. The PDBu-induced fall in basal IAS smooth muscle tone and [Ca(2+)](i) resembled that induced by the Ca(2+) channel blocker nifedipine and were reversed specifically by the Ca(2+) channel activator BAY K 8644. We speculate that a major component of the relaxant action of PDBu in IAS smooth muscle is caused by the inhibition of Ca(2+) influx and of PKC translocation to the membrane. The specific role of PKC downregulation and other factors in the phorbol ester-mediated fall in basal IAS smooth muscle tone remain to be determined. PMID:11352829

Chakder, S; Sarma, D N; Rattan, S

2001-06-01

233

Purse-string morphology of external anal sphincter revealed by novel imaging techniques.  

PubMed

The external anal sphincter (EAS) may be injured in 25-35% of women during the first and subsequent vaginal childbirths and is likely the most common cause of anal incontinence. Since its first description almost 300 years ago, the EAS was believed to be a circular or a "donut-shaped" structure. Using three-dimensional transperineal ultrasound imaging, MRI, diffusion tensor imaging, and muscle fiber tracking, we delineated various components of the EAS and their muscle fiber directions. These novel imaging techniques suggest "purse-string" morphology, with "EAS muscles" crossing contralaterally in the perineal body to the contralateral transverse perineal (TP) and bulbospongiosus (BS) muscles, thus attaching the EAS to the pubic rami. Spin-tag MRI demonstrated purse-string action of the EAS muscle. Electromyography of TP/BS and EAS muscles revealed their simultaneous contraction and relaxation. Lidocaine injection into the TP/BS muscle significantly reduced anal canal pressure. These studies support purse-string morphology of the EAS to constrict/close the anal canal opening. Our findings have implications for the effect of episiotomy on anal closure function and the currently used surgical technique (overlapping sphincteroplasty) for EAS reconstructive surgery to treat anal incontinence. PMID:24458022

Mittal, Ravinder K; Bhargava, Valmik; Sheean, Geoff; Ledgerwood, Melissa; Sinha, Shantanu

2014-03-01

234

Brachytherapy and Local Excision for Sphincter Preservation in T1 and T2 Rectal Cancer  

SciTech Connect

Purpose: To report long-term results of brachytherapy after local excision (LE) in the treatment of T1 and T2 rectal cancer at risk of recurrence due to residual subclinical disease. Methods and Materials: Between 1989 and 2007, 32 patients undergoing LE and brachytherapy were followed prospectively for a mean of 6.2 years. Estimates of local recurrence (LR), disease-specific survival (DSS), and overall survival (OS) were generated. Treatment-related toxicity and the effect of known prognostic factors were determined. Results: There were 8 LR (3 T1, 5 T2), of which 5 were salvaged surgically. Median time to the 8 LR was 14 months, and the 5-year rate of local control was 76%. Although there have been 9 deaths to date, only 5 were from disease. Five-year DSS and OS rates were 85% and 78%, respectively. There were 4 cases of Grade 2-3 radionecrosis and 1 case of mild stool incontinence. The sphincter was preserved in 27 of 32 patients. Conclusion: Local excision and adjuvant brachytherapy for T1 and T2 rectal cancer is an appealing treatment alternative to immediate radical resection, particularly in the frail and elderly who are unable to undergo major surgery, as well as for patients wanting to avoid a permanent colostomy.

Grimard, Laval [Division of Radiation Oncology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario (Canada)], E-mail: lgrimard@ottawahospital.on.ca; Stern, Hartley [Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ontario (Canada); Spaans, Johanna N. M.Sc. [Division of Radiation Oncology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario (Canada)

2009-07-01

235

Disturbed Colonic Motility Contributes to Anorectal Symptoms and Dysfunction After Radiotherapy for Carcinoma of the Prostate  

SciTech Connect

Purpose: To evaluate the role of colonic motility in the pathogenesis of anorectal symptoms and dysfunction after radiotherapy (RT) for carcinoma of the prostate. Patients and Methods: Thirty-eight patients, median age 71 (range, 50-81) years with localized prostate carcinoma randomized to one of two radiation dose schedules underwent colonic transit scintigraphy and assessment of anorectal symptoms (questionnaire), anorectal function (manometry), and anal sphincteric morphology (endoanal ultrasound) before and at 1 month and 1 year after RT. Results: Whole and distal colonic transit increased 1 month after RT, with faster distal colonic transit only persisting at 1 year. Frequency and urgency of defecation, fecal incontinence, and rectal bleeding increased 1 month after RT and persisted at 1 year. Basal anal pressures remained unchanged, but progressive reductions occurred in anal squeeze pressures and responses to increased intra-abdominal pressure. Rectal compliance decreased progressively in the patients, although no changes in anorectal sensory function ensued. Radiotherapy had no effect on the morphology of the internal and external anal sphincters. Distal colonic retention was weakly related to rectal compliance at 1 month, but both faster colonic transit and reduced rectal compliance were more frequent with increased fecal urgency. At 1 year, a weak inverse relationship existed between colonic half-clearance time and frequency of defecation, although both faster whole-colonic transit and reduced rectal compliance occurred more often with increased stool frequency. Conclusion: Colonic dysmotility contributes to anorectal dysfunction after RT for carcinoma of the prostate. This has implications for improving the management of anorectal radiation sequelae.

Yeoh, Eric K., E-mail: eric.yeoh@health.sa.gov.a [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA (Australia); Bartholomeusz, Dylan L. [Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, SA (Australia); Holloway, Richard H. [Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, SA (Australia); Fraser, Robert J. [Gastrointestinal Investigation Unit, Repatriation General Hospital, Daw Park, SA (Australia); Botten, Rochelle; Di Matteo, Addolorata [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA (Australia); Moore, James W. [Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide, SA (Australia); Schoeman, Mark N. [Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, SA (Australia)

2010-11-01

236

DNA strand breaks, cytochrome P-450-dependent monooxygenase system activity and levels of chlorinated biphenyl congeners in the pyloric caeca of the seastar (Asterias rubens) from the North Sea  

Microsoft Academic Search

Seastars (Asterias rubens L.) were collecte d at sampling locations in different areas along transects radiating into the southern North Sea, representing areas impacted by contaminants to different degrees. Strand breakage in DNA isolated from tissue of the pyloric caeca was measured by the alkaline unwinding assay, modified to allow for the isolation of highly intact DNA. The interpretation of

J. M. Everaarts; P. J. Den Besten; M. Th. J. Hillebrand; R. S. Halbrook; L. R. Shugart

1998-01-01

237

[Thyroid dysfunction in pregnancy].  

PubMed

Thyroid dysfunction may impair fertility, course of pregnancy and fetal development. Physiological alterations of thyroid function parameters, that occur during pregnancy need to be distinguished from pathophysiological states of hypo- and hyperthyroidism. We performed a literature search (PubMed 1990-2013) and review relevant publications as well as consensus and practice guidelines of international thyroid/endocrine societies. Interpretation of thyroid function values in pregnancy must be based on trimester-specific TSH and T4 ranges. Alterations in thyroid function are present in up to 15% of pregnancies (0.4% overt hypothyroidism, 0.1-0.4% hyperthyroidism) and may lead to preventable complications in the pregnant woman and the fetus. Hypothyroidism is associated with an increased risk for abortion, premature delivery and stillbirth, besides impairment of neurocognitive development. The latter has also been shown in situations of grave iodine deficiency. In addition to new-born screening directed at early recognition of congenital hypothyroidism (incidence 0.03%), universal screening of all pregnant women should be implemented in health care guidelines. Newly diagnosed overt hypothyroidism in a pregnant woman requires immediate levothyroxine substitution at adequate doses. In subclinical hypothyroidism thyroid hormone replacement should be considered. Iodine supplementation is strongly recommended in all pregnant and breast-feeding women. Pregnancy causes a number of, that need to be of thyroid dysfunction. Both hypothyroidism and thyrotoxicosis may impair the course of pregnancy and may negatively affect the fetus. In particular, maternal hypothyroidism may lead to irreparable and detrimental deficits in the neurocognitive development of the fetus. Autoimmune thyroid disease is the most common cause of thyroid dysfunction in pregnancy. Hashimoto's thyroiditis is associated with impaired fertility and miscarriage, and may first manifest in pregnancy due to the increased thyroid hormone requirement. Graves' disease often shows a characteristic course in pregnancy with amelioration of thyrotoxicosis in the second half of pregnancy and exacerbation after delivery. In addition transplacental passage of maternal TSH receptor antibodies may lead to thyrotoxicosis in the fetus and/or newborn. PMID:25289925

Führer, D; Mann, K; Feldkamp, J; Krude, H; Spitzweg, C; Kratzsch, J; Schott, M

2014-10-01

238

Psychotropics and sexual dysfunction  

PubMed Central

Introduction Sexual dysfunction (SD) is common in patients taking antipsychotics, and is the most bothersome symptom and adverse drug effect compromising treatment compliance. Mechanisms involved in psychotropics–induced SD are either largely unknown or poorly understood. The aim of this review is to present an updated analysis of SD associated with the use of psychotropic drugs in psychiatric patients. Results Contemporary evidence from available studies demonstrates that SD rates are drug–related rather than drug–class specific, and that these rates vary widely. Mechanisms involved in psychotropics–induced SD are either largely unknown or poorly understood. Our understanding of psychotropics–induced SD is limited by the inability to differentiate whether these effects are really drug–induced or due to different inclusion criteria. Conclusions Rigorous research, basic and clinical, is needed to understand the exact incidence, severity and mechanisms involved in the development of SD induced by various psychotropic treatment regimens. PMID:24757547

Bella, Anthony J.

2013-01-01

239

Investigation of erectile dysfunction  

PubMed Central

Erectile dysfunction (ED) represents a common and debilitating condition with a wide range of organic and non-organic causes. Physical aetiologies can be divided into disorders affecting arterial inflow, the venous occlusion mechanism or the penile structure itself. Various imaging modalities can be utilised to investigate the physical causes of ED, but penile Doppler sonography (PDS) is the most informative technique, indicated in those patients with ED who do not respond to oral pharmacological agents (e.g. phosphodiesterase type 5 inhibitors). This review will examine the anatomical and physiological basis of penile erection, the method for performing PDS and features of specific causes of ED, and will also consider the alternative imaging modalities available. PMID:23118101

Patel, D V; Halls, J; Patel, U

2012-01-01

240

External urethral sphincter motoneuron properties in adult female rats studied in vitro.  

PubMed

The external urethral sphincter (EUS) muscle plays a crucial role in lower urinary tract function: its activation helps maintain continence, whereas its relaxation contributes to micturition. To determine how the intrinsic properties of its motoneurons contribute to its physiological function, we have obtained intracellular current-clamp recordings from 49 EUS motoneurons in acutely isolated spinal cord slices from adult female rats. In all, 45% of EUS motoneurons fired spontaneously and steadily (average rate = 12-27 pulses/s). EUS motoneurons were highly excitable, having lower rheobase, higher input resistance, and smaller threshold depolarization than those of rat hindlimb motoneurons recorded in vitro. Correlations between these properties and afterhyperpolarization half-decay time are consistent with EUS motoneurons having characteristics of both fast and slow motor unit types. EUS motoneurons with a slow-like spectrum of properties exhibited spontaneous firing more often than those with fast-like characteristics. During triangular current ramp-induced repetitive firing, recruitment typically occurred at lower current levels than those at derecruitment, although the opposite pattern occurred in 10% of EUS motoneurons. This percentage was likely underestimated due to firing rate adaptation. These findings are consistent with the presence of a basal level of persistent inward current (PIC) in at least some EUS motoneurons. The low EUS motoneuron current and voltage thresholds make them readily recruitable, rendering them well suited to their physiological role in continence. The expression of firing behaviors consistent with PIC activation in this highly reduced preparation raises the possibility that in the intact animal, PICs contribute to urinary function not only through neuromodulator-dependent but also through neuromodulator-independent mechanisms. PMID:20573976

Carp, Jonathan S; Tennissen, Ann M; Liebschutz, Jennifer E; Chen, Xiang Yang; Wolpaw, Jonathan R

2010-09-01

241

External Urethral Sphincter Motoneuron Properties in Adult Female Rats Studied In Vitro  

PubMed Central

The external urethral sphincter (EUS) muscle plays a crucial role in lower urinary tract function: its activation helps maintain continence, whereas its relaxation contributes to micturition. To determine how the intrinsic properties of its motoneurons contribute to its physiological function, we have obtained intracellular current-clamp recordings from 49 EUS motoneurons in acutely isolated spinal cord slices from adult female rats. In all, 45% of EUS motoneurons fired spontaneously and steadily (average rate = 12–27 pulses/s). EUS motoneurons were highly excitable, having lower rheobase, higher input resistance, and smaller threshold depolarization than those of rat hindlimb motoneurons recorded in vitro. Correlations between these properties and afterhyperpolarization half-decay time are consistent with EUS motoneurons having characteristics of both fast and slow motor unit types. EUS motoneurons with a slow-like spectrum of properties exhibited spontaneous firing more often than those with fast-like characteristics. During triangular current ramp-induced repetitive firing, recruitment typically occurred at lower current levels than those at derecruitment, although the opposite pattern occurred in 10% of EUS motoneurons. This percentage was likely underestimated due to firing rate adaptation. These findings are consistent with the presence of a basal level of persistent inward current (PIC) in at least some EUS motoneurons. The low EUS motoneuron current and voltage thresholds make them readily recruitable, rendering them well suited to their physiological role in continence. The expression of firing behaviors consistent with PIC activation in this highly reduced preparation raises the possibility that in the intact animal, PICs contribute to urinary function not only through neuromodulator-dependent but also through neuromodulator-independent mechanisms. PMID:20573976

Tennissen, Ann M.; Liebschutz, Jennifer E.; Chen, Xiang Yang; Wolpaw, Jonathan R.

2010-01-01

242

Esophageal wall blood perfusion during contraction and transient lower esophageal sphincter relaxation in humans  

PubMed Central

We recently reported that esophageal contraction reduces esophageal wall perfusion in an animal study. Our aim was to determine esophageal wall blood perfusion (EWBP) during esophageal contraction and transient lower esophageal sphincter relaxations (TLESRs) in humans. We studied 12 healthy volunteers. A custom-designed laser Doppler probe was anchored to the esophageal wall, 4–6 cm above the LES, by use of the Bravo pH system so that the laser light beam stay directed toward the esophageal mucosa. A high-resolution manometry equipped with impedance electrodes recorded esophageal pressures and reflux events. Synchronized pressure, impedance, pH, and EWBP recordings were obtained during dry and wet swallows and following a meal. Stable recordings of laser Doppler EWBP were only recorded when the laser Doppler probe was firmly anchored to the esophageal wall. Esophageal contractions induced by dry and wet swallows resulted in 46 ± 9% and 60 ± 10% reduction in the EWBP, respectively (compared to baseline). Reduction in EWBP was directly related to the amplitude (curvilinear fit) and duration of esophageal contraction. Atropine reduced the esophageal contraction amplitude and decreased the EWBP reduction associated with esophageal contraction. TLESRs were also associated with reduction in the EWBP, albeit of smaller amplitude (29 ± 3%) but longer duration (19 ± 2 s) compared with swallow-induced esophageal contractions. We report 1) an innovative technique to record EWBP for extended time periods in humans and 2) contraction of circular and longitudinal muscle during peristalsis and selective longitudinal muscle contraction during TLESR causes reduction in the EWBP; 3) using our innovative technique, future studies may determine whether esophageal wall ischemia is the cause of esophageal pain/heartburn. PMID:22790599

Jiang, Yanfen; Bhargava, Valmik; Kim, Young Sun

2012-01-01

243

Castanea sativa Mill. extract contracts gallbladder and relaxes sphincter of Oddi in guinea pig: a natural approach to biliary tract motility disorders.  

PubMed

Impaired gallbladder motility is a contributing factor to gallstone formation. Since many drugs delaying intestinal motility inhibit gallbladder emptying, the aim of the present study was to evaluate the effect on gallbladder and sphincter of Oddi motility of a Natural Chestnut Wood Extract (NEC) that reduces intestinal motility. In order to evaluate the effect of the extract in normal- and high-risk gallstone conditions, the investigation was performed using tissues from animals fed normal and lithogenic diet. Fifty guinea pigs were administered either control or lithogenic diet. The spontaneous motility of the gallbladder and sphincter of Oddi were recorded on isolated gallbladder tissues; thereafter, the effect of NEC on motility was tested and compared with carbachol (CCh), potassium chloride (KCl), noradrenaline (NA), and A71623. Compared to controls, the lithogenic diet induced an irregular and disordered motor pattern in both the gallbladder and sphincter of Oddi. NEC increased gallbladder and decreased sphincter of Oddi spontaneous motility independently of cholinergic, adrenergic, and CCK-1 receptor-mediated pathways both in controls and in lithogenic diet-fed animals, although the effect was lower in the latter group. The effect was reversible and mediated by calcium channels. The natural extract of chestnut increasing gallbladder contraction and inducing the relaxation of the sphincter of Oddi can be of benefit in pathological conditions associated with increased transit time at risk of gallstones. PMID:24654975

Micucci, Matteo; Ioan, Pierfranco; Aldini, Rita; Cevenini, Monica; Alvisi, Vittorio; Ruffilli, Corrado; Chiarini, Alberto; Budriesi, Roberta

2014-07-01

244

D-serine modulates non-adrenergic non-cholinergic contraction of lower esophageal sphincter in rats.  

PubMed

Endogenous D-serine is known to modulate glutamatergic transmission via interaction with the glycine site of N-methyl-D-aspartate (NMDA) receptors. D-serine is synthesized by racemization of L-serine using an enzymatic reaction catalyzed by serine racemase. Although much attention has been focused on the role of D-serine within the central nervous system, the physiological role of D-serine in enteric nervous system has not been investigated. Lower esophageal sphincter (LES) function is known to be modulated by NMDA-dependent mechanisms. The present study was aimed to study the expression of enzymes involved in D-serine metabolism and the function of D-serine in lower esophageal sphincter in rats. Reverse transcription polymerase chain reaction (RT-PCR) and western blotting showed the expression of serine racemase in isolated rat LES. Electrical field stimulation was used to induce non-adrenergic non-cholinergic (NANC) contraction/relaxation of isolated rat LES in an organ bath using an isometric force transducer. The organ bath studies on isolated rat LES showed that incubation with D-serine (100 ?M) is associated with a significant increase in the NANC contraction of isolated LES. This effect of exogenous D-serine was inhibited by NMDA receptor antagonists (MK-801), suggesting that NMDA receptors are involved in the effects of D-serine on NANC contraction of LES. Incubation with D-serine did not show a significant effect on NANC relaxation within our experimental setting. The results of this study suggest that serine racemase is expressed in LES and D-serine modulates contraction of the lower esophageal sphincter in rats. PMID:23022330

Ghasemi-Kasman, Maryam; Dehpour, Ahmad R; Mani, Ali R

2012-12-01

245

Understanding brain dysfunction in sepsis  

PubMed Central

Sepsis often is characterized by an acute brain dysfunction, which is associated with increased morbidity and mortality. Its pathophysiology is highly complex, resulting from both inflammatory and noninflammatory processes, which may induce significant alterations in vulnerable areas of the brain. Important mechanisms include excessive microglial activation, impaired cerebral perfusion, blood–brain-barrier dysfunction, and altered neurotransmission. Systemic insults, such as prolonged inflammation, severe hypoxemia, and persistent hyperglycemia also may contribute to aggravate sepsis-induced brain dysfunction or injury. The diagnosis of brain dysfunction in sepsis relies essentially on neurological examination and neurological tests, such as EEG and neuroimaging. A brain MRI should be considered in case of persistent brain dysfunction after control of sepsis and exclusion of major confounding factors. Recent MRI studies suggest that septic shock can be associated with acute cerebrovascular lesions and white matter abnormalities. Currently, the management of brain dysfunction mainly consists of control of sepsis and prevention of all aggravating factors, including metabolic disturbances, drug overdoses, anticholinergic medications, withdrawal syndromes, and Wernicke’s encephalopathy. Modulation of microglial activation, prevention of blood–brain-barrier alterations, and use of antioxidants represent relevant therapeutic targets that may impact significantly on neurologic outcomes. In the future, investigations in patients with sepsis should be undertaken to reduce the duration of brain dysfunction and to study the impact of this reduction on important health outcomes, including functional and cognitive status in survivors. PMID:23718252

2013-01-01

246

Palliation of Pyloric Stenosis Caused by Gastric Cancer Using an Endoscopically Placed Covered Ultraflex Stent: Covered Stent Inside an Occluded Uncovered Stent  

SciTech Connect

A 71-year-old man developed pyloric stenosis caused by gastric cancer. Vomiting and nausea resolved after the insertion of an uncovered Ultraflex stent (length 10 cm, inner diameter 18u23 mm) through a 7-cm-long stenosis, and the patient was able to eat a soft diet. After 6 weeks, stent occlusion occurred due to tumor ingrowth and accumulation of food residue. Endoscopic observation showed a very narrow residual lumen. A covered Ultraflex stent (length 10 cm, inner diameter 18u23 mm) was inserted through the first stent and expanded to its maximum diameter over the next 2 days. The patient's vomiting and nausea improved rapidly. He died 6 months after the second stenting procedure, from metastatic tumor spread, having remained free of nausea and vomiting. In this case, a covered metallic stent prevented tumor ingrowth and maintained gastrointestinal patency.

Nakamura, Toshifumi; Kitagawa, Mutsuo; Takehira, Yasunori; Yamada, Masami [Department of Gastroenterology, Hamamatsu Medical Center, 328 Tomitsuka-cho, Hamamatsu, Shizuoka 432-8580 (Japan); Nishiwaki, Yoshiro [Department of Surgery, Hamamatsu Medical Center, 328 Tomitsuka-cho, Hamamatsu, Shizuoka 432-8580 (Japan); Nakamura, Hirotoshi [Second Department of Internal Medicine, Hamamatsu University School of Medicine, 3600 Handa-cho, Hamamatsu, Shizuoka 431-3192 (Japan)

2000-07-15

247

[Hormonal etiology in erectile dysfunction].  

PubMed

The proper function of erection mechanisms depend on correct interrelationship between psychological, vascular, neurological and hormonal factors. Endocrine diseases affect sexual function, and sexual dysfunction may be one of the symptoms of some hormonal anomalies. Diabetes mellitus is the endocrine disease most frequently causing erectile dysfunction due to the frequent vascular and neurological complications associated. It is important to determine blood glucose in the initial evaluation of a male with erectile dysfunction, as well as to try an adequate control of blood glucose levels to avoid worsening. Diabetic male erectile dysfunction is multifactorial, more severe and has worse response to oral treatment. Hyperprolactinemia causes disorders of the sexual sphere because it produces a descent of testosterone. In these cases, sexual symptoms are treated by correcting the levels of prolactin. Routine determination of prolactin is not clear and it seems it should be determined when testosterone levels are diminished. Thyroid hormone disorders (both hyper and hypotyroidism) are associated with erectile dysfunction, which will subside in half the patients with thyroid hormone normalization. The role of adrenal hormones in erectile function is not clear and their routine determination is not considered in the diagnostic evaluation of erectile dysfunction. The role of estradiol in the regulation of the erection mechanism is not well known either, although it is known that high levels may cause erectile dysfunction. Among endocrine-metabolic disorders we point out dyslipemias, with hypercholesterolemia as an important risk factor for erectile dysfunction and, though its correction may prevent vascular system deterioration, the role of statins in erectile dysfunction is not clear. PMID:20978293

Jabaloyas, José María Martínez

2010-10-01

248

Markers of erectile dysfunction  

PubMed Central

With the development and marketing of oral pharmacotherapy that is both noninvasive and successful in treating erectile dysfunction (ED), the quest to identify markers of organic ED lost ground. Indeed, the multi-factorial nature of ED may have led many researchers to conclude that searching for a universal marker of ED was futile. However, the realization that ED is strongly correlated with the overall health of men, and may act as a predictor for the development of cardiovascular disease (CVD) and diabetes, has stimulated interest in identifying genes that can distinguish organic ED. In addition, the potential ability to suggest to the patient that ED is reversible (i.e., psychogenic) with a simple test would be of significance to both the physician and patient, as well as for reimbursement issues for therapy by insurance companies. Such a marker may also act as a non-subjective measure of the degree of ED and the efficacy of treatment. This review discusses the importance of identifying such markers and recent work identifying potential markers in human patients. PMID:19468461

Davies, Kelvin P.; Melman, Arnold

2008-01-01

249

Reactive airways dysfunction syndrome.  

PubMed

Reactive airways dysfunction syndrome (RADS) is an asthma-like bronchoconstriction state which develops after a short-term exposure to highly irritating volatile substances. Although some of the clinical manifestations can be considered as very similar to those of asthma (e. g. inflammation, hyperresponsiveness and reversibility of the bronchial constriction) the most essential difference lies in the absence of asthma attacks after exposure to small amounts of causative agents few weeks after onset. Thus, the mechanism of RADS cannot be considered to be of an allergic origin. This is supported by the results of the pathomorphologic biopsies taken from bronchi which usually show neutrophilic and lymphocytic infiltrations as well as frequent and severe destruction of the bronchial epithelium. Eosinophilic infiltrations and basement membrane thickness have never been found. The therapy of severe dyspnoea attacks is similar to that of bronchial asthma. Factors that cause RADS comprise a wide range of volatile irritant substances, provided that they occur in high concentrations. Exposure to isocyanates in plumbers heating polyurethane pipes seems to be the major cause of RADS in Poland. PMID:7820384

Pa?czy?ski, C; Jakubowski, J; Górski, P

1994-01-01

250

The role of botulinum toxin injection and upper esophageal sphincter myotomy in treating oropharyngeal dysphagia.  

PubMed

The aims of this study were to assess the efficacy and safety of botulinum toxin (BoTox) injection in the cricopharyngeus muscle (CP) and CP myotomy in patients with oropharyngeal dysphagia (OPD) and to identify factors predicting the outcome of these treatments. The study involved patients with persistent OPD despite 2-6 months of rehabilitation, who all underwent clinical evaluation, esophageal manometry, upper gastrointestinal endoscopy, and videofluoroscopy (VFS). Patients received 5-10 BoTox units injections in the CP, identified by electromyography. Surgical myotomy of the upper esophageal sphincter was performed when dysphagia persisted after two BoTox injections. After treatment, patients were reevaluated with clinical interviews and VFS. The study population included 21 patients (15 mean and 6 women; median age, 68 years), classified into three groups, based on the etiology of their OPD: eight (38%) had central nervous system abnormalities, five (24%) had peripheral nerve disease, and eight (38%) were classified as idiopathic. The median time since the onset of dysphagia was 18 months. Thirteen of 21 patients (62%) needed supplemental/total gastrostomy feeding, and 5 of 21 (24%) had tracheostomy. One patient died, on posttreatment day 7, due to massive aspiration. No other BoTox-related complications were observed. After BoTox injection, dysphagia improved in 9 of 21 (43%) patients. Severely altered VFS findings and CP incoordination or low activity predicted BoTox failure at multivariate analysis. Dysphagia improved in 8 of 11 (72.7%) patients who failed to respond to BoTox and underwent myotomy. A mild impairment of VFS findings and a higher pressure of pharyngeal contractions best predicted response to BoTox with or without myotomy. BoTox injection can be used as the first therapeutic option in patients with OPD: it is safe and simple and relieves dysphagia in 43% of cases. If BoTox fails, CP myotomy can be offered to patients with preserved oral and tongue activity at VFS and an intact bolus propulsion ability on manometry. PMID:15585387

Zaninotto, Giovanni; Marchese Ragona, Rosario; Briani, Chiara; Costantini, Mario; Rizzetto, Christian; Portale, Giuseppe; Zanetti, Lia; Masiero, Stefano; Costantino, Michela; Nicoletti, Loredana; Polidoro, Alessandro; Feltrin, GianPiero; Angelini, Corrado; Ancona, Ermanno; Guidolin, Diego; Parenti, Anna R

2004-12-01

251

Newborn endothelin receptor type B mutant (piebald) mice have a higher resting anal sphincter pressure than newborn C57BL/6 mice.  

PubMed

Hirschsprung's disease is characterized by aganglionosis of the distal colon and hypertonicity of the anal sphincter. Endothelin receptor type B mutant (piebald) mice phenotypically resemble infants with Hirschsprung's disease in that these mice are susceptible to developing toxic megacolon because of the absence of ganglion cells in their distal colon. Therefore, we hypothesized that newborn piebald mice would have a higher resting anal sphincter pressure than would newborn wild-type mice. To test this hypothesis, we developed a reliable and reproducible technique for measuring the resting anal sphincter pressure in mice. Heterozygote breeding pairs of endothelin receptor type B mutant mice were purchased and bred in our animal facility. Pregnant, time-dated C57BL/6J mice provided control newborn mice. One-day-old newborn mice were evaluated for resting anal sphincter pressure. Under the operating microscope, a 24-gauge open-tip epidural catheter was placed into the anus until a deflection (approximately 3 to 5 mm) was noticed on a polygraph pressure monitor. Three consecutive measurements were obtained for each mouse. Mean values for each group were determined and compared using Student's t test. The resting anal sphincter pressure (mean +/- standard deviation) in newborn C57BL/6J mice was 13.3 +/- 2.6 mmHg, whereas that in piebald mice 22.7 +/- 2.5 mmHg (P < 0.0001). Therefore, because of their increased resting anal sphincter pressure, piebald mice may provide a useful animal model for the study of Hirschsprung's disease. PMID:14615959

Nadler, Evan P; Boyle, Patricia; Murdock, Alan D; Dilorenzo, Carlo; Barksdale, Edward M; Ford, Henri R

2003-11-01

252

Causes of sexual dysfunction (image)  

MedlinePLUS

Female sexual dysfunction describes women who are indifferent or hostile to sexual intercourse, who have no response to sexual advances or stimulation, or who are unable to have an orgasm during sexual intercourse.

253

Mitochondrial Dysfunction and Bipolar Disorder  

Microsoft Academic Search

\\u000a The mitochondrial dysfunction hypothesis was proposed to integrate various findings in bipolar disorder (BPD). This hypothesis\\u000a is supported by possible roles of maternal inheritance, comorbidity with mitochondrial diseases, the mechanism of action of\\u000a mood stabilizers, magnetic resonance spectroscopy, mitochondrial DNA mutations, gene expression analysis, and phenotypes of\\u000a animal models. Mitochondrial dysfunction is not specific to BPD but is common to

Tadafumi Kato

254

Gene Therapy for Erectile Dysfunction  

Microsoft Academic Search

Our current understanding of the underlying mechanisms of erectile dysfunction suggests that gene therapy will become a therapeutic\\u000a treatment in the near future. Over the past decade, erectile dysfunction has been ameliorated in animal models using viral-and\\u000a plasmid-based vectors. Genes that stimulate smooth muscle cell relaxation, such as neuronal, inducible, and endothelial nitric\\u000a oxide synthase, or that inhibit smooth muscle

Thomas R. Magee; Jacob Rajfer; Nestor F. Gonzalez-Cadavid

255

Evaluation of Male Sexual Dysfunction  

Microsoft Academic Search

\\u000a The management of male sexual dysfunction and specifically erectile dysfunction (ED) has seen major changes in each decade\\u000a since the 1970s thanks to the discovery that a papaverine injection could produce erection, the NIH Consensus Statement which\\u000a defined ED in 1992, advances in minimally invasive diagnostics, and the development of orally effective erectogenic class\\u000a of drugs, the phosphodiesterase type-5 inhibitors

Gregory A. Broderick

256

Adenosine dysfunction in epilepsy  

PubMed Central

Extracellular levels of the brain’s endogenous anticonvulsant and neuroprotectant adenosine largely depend on an astrocyte-based adenosine cycle, comprised of ATP release, rapid degradation of ATP into adenosine, and metabolic reuptake of adenosine through equilibrative nucleoside transporters and phosphorylation by adenosine kinase (ADK). Changes in ADK expression and activity therefore rapidly translate into changes of extracellular adenosine, which exerts its potent anticonvulsive and neuroprotective effects by activation of pre- and postsynaptic adenosine A1 receptors. Increases in ADK increase neuronal excitability, whereas decreases in ADK render the brain resistant to seizures and injury. Importantly, ADK was found to be overexpressed and associated with astrogliosis and spontaneous seizures in rodent models of epilepsy, as well as in human specimen resected from patients with hippocampal sclerosis and temporal lobe epilepsy. Several lines of evidence indicate that overexpression of astroglial ADK and adenosine deficiency are pathological hallmarks of the epileptic brain. Consequently, adenosine augmentation therapies constitute a powerful approach for seizure prevention, which is effective in models of epilepsy that are resistant to conventional antiepileptic drugs. The adenosine kinase hypothesis of epileptogenesis suggests that adenosine dysfunction in epilepsy undergoes a biphasic response: An acute surge of adenosine that can be triggered by any type of injury might contribute to the development of astrogliosis via adenosine receptor –dependent and –independent mechanisms. Astrogliosis in turn is associated with overexpression of ADK, which was shown to be sufficient to trigger spontaneous recurrent electrographic seizures. Thus, ADK emerges as a promising target for the prediction and prevention of epilepsy. PMID:22700220

Boison, Detlev

2011-01-01

257

Erectile dysfunction in patients with cardiovascular disease  

PubMed Central

Erectile dysfunction is a highly prevalent disease, especially in cardiovascular-compromised men. Many of the well-established risk factors for cardiovascular disease are also risk factors for erectile dysfunction. A correlation between erectile dysfunction and endothelial dysfunction is well established. It is postulated that erectile dysfunction with an arteriovascular aetiology can predate and be an indicator of potential coronary artery disease. In this paper we will attempt to increase awareness among cardiologists for the predictive value of erectile dysfunction for future cardiovascular disease in order to optimise cardiovascular risk management. The treatment of erectile dysfunction and cardiovascular interactions is also discussed in detail. ImagesFigure 1AFigure 1B

Ophuis, A.J.M. Oude; Nijeholt, A.A.B. Lycklama a

2006-01-01

258

Bladder dysfunction changes from underactive to overactive after experimental traumatic brain injury.  

PubMed

Although bladder dysfunction is common after traumatic brain injury (TBI), few studies have investigated resultant bladder changes and the detailed relationship between TBI and bladder dysfunction. The goal of this study was to characterize the effects of TBI on bladder function in an animal model. Fluid-percussion injury was used to create an animal model with moderate TBI. Female Sprague-Dawley rats underwent TBI, sham TBI or were not manipulated (naïve). All rats underwent filling cystometry while bladder pressure and external urethral sphincter electromyograms were simultaneously recorded 1 day, 1 week, 2 weeks, and 1 month after injury. One day after injury, 70% of the animals in the TBI group and 29% of the animals in the sham TBI group showed no bursting activity during urination. Compared to naïve rats, bladder function was mainly altered 1 day and 1 week after sham TBI, suggesting the craniotomy procedure affected bladder function mostly in a temporary manner. Compared to either naïve or sham TBI, bladder weight was significantly increased 1 month after TBI and collagen in the bladder wall was increased. Bladder function in the TBI group went from atonic 1 day post-TBI to overactive 1 month post-TBI, suggesting that TBI significantly affected bladder function. PMID:23178579

Jiang, Hai-Hong; Kokiko-Cochran, Olga N; Li, Kevin; Balog, Brian; Lin, Ching-Yi; Damaser, Margot S; Lin, Vernon; Cheng, Julian Yaoan; Lee, Yu-Shang

2013-02-01

259

Argon Plasma Coagulation Therapy Versus Topical Formalin for Intractable Rectal Bleeding and Anorectal Dysfunction After Radiation Therapy for Prostate Carcinoma  

SciTech Connect

Purpose: To evaluate and compare the effect of argon plasma coagulation (APC) and topical formalin for intractable rectal bleeding and anorectal dysfunction associated with chronic radiation proctitis. Methods and Materials: Thirty men (median age, 72 years; range, 49-87 years) with intractable rectal bleeding (defined as ?1× per week and/or requiring blood transfusions) after radiation therapy for prostate carcinoma were randomized to treatment with APC (n=17) or topical formalin (n=13). Each patient underwent evaluations of (1) anorectal symptoms (validated questionnaires, including modified Late Effects in Normal Tissues–Subjective, Objective, Management, and Analytic and visual analogue scales for rectal bleeding); (2) anorectal motor and sensory function (manometry and graded rectal balloon distension); and (3) anal sphincteric morphology (endoanal ultrasound) before and after the treatment endpoint (defined as reduction in rectal bleeding to 1× per month or better, reduction in visual analogue scales to ?25 mm, and no longer needing blood transfusions). Results: The treatment endpoint was achieved in 94% of the APC group and 100% of the topical formalin group after a median (range) of 2 (1-5) sessions of either treatment. After a follow-up duration of 111 (29-170) months, only 1 patient in each group needed further treatment. Reductions in rectal compliance and volumes of sensory perception occurred after APC, but no effect on anorectal symptoms other than rectal bleeding was observed. There were no differences between APC and topical formalin for anorectal symptoms and function, nor for anal sphincteric morphology. Conclusions: Argon plasma coagulation and topical formalin had comparable efficacy in the durable control of rectal bleeding associated with chronic radiation proctitis but had no beneficial effect on anorectal dysfunction.

Yeoh, Eric, E-mail: eric.yeoh@health.sa.gov.au [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide (Australia); School of Medicine, University of Adelaide, Adelaide (Australia); Tam, William; Schoeman, Mark [School of Medicine, University of Adelaide, Adelaide (Australia); Department of Gastroenterology, Royal Adelaide Hospital, Adelaide (Australia); Moore, James; Thomas, Michelle [School of Medicine, University of Adelaide, Adelaide (Australia); Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide (Australia); Botten, Rochelle; Di Matteo, Addolorata [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide (Australia)

2013-12-01

260

MAYO CLINIC LONG-TERM ANALYSIS OF THE FUNCTIONAL DURABILITY OF THE AMS 800 ARTIFICIAL URINARY SPHINCTER: A REVIEW OF 323 CASES  

Microsoft Academic Search

PurposeWe determine the long-term durability of the AMS 800? artificial urinary sphincter in the correction of severe urinary incontinence, and evaluate mechanical versus nonmechanical failure and reoperation rates before (1983 to 1987) and after (1988 to present) the introduction of the narrow backing occlusive cuff design.' American Medical Systems, Inc., Minnetonka, Minnesota.

DANIEL S. ELLIOTT; DAVID M. BARRETT

1998-01-01

261

Functional sphincter ani externus reconstruction for treatment of fecal stress incontinence using free latissimus dorsi muscle transfer with coaptation to the pudendal nerve: preliminary experimental study in dogs.  

PubMed

The external anal sphincter (EAS) is a skeletal muscle capable of voluntary contraction to prevent accidental defecation. Current reconstructive options for a severely damaged EAS using local muscle flaps are not always adequate for functional repair. The present preliminary experimental model was designed to assess the feasibility of a neuromicrovascular latissimus dorsi muscle transfer for functional external spincter muscle reconstruction. In nine mongrel dogs, the anal sphincter muscles were totally resected, leaving a mucosal canal in place. A segmental latissimus dorsi muscle was shaped around the anal canal in a circular fashion, with coaptation to the pudendal nerve, and vessel anastomosis at the ischiorectal fossa. Functional evaluation was performed using electromyogram, sphincter manometry, video documentation, and histologic examination with standard and immunohistochemical staining. After 8 months, the remaining three eligible dogs were continent. Muscle function was verified by means of electromyogram, sphincter manometry, and a video record. Histologic and immunohistochemical examination confirmed the functional results, showing only minor zones of fatty and fibrous degeneration. Transplantation of a segmental latissimus dorsi muscle with vascular anastomosis and coaptation to the pudendal nerve has proved to be successful in restoring (voluntary) anal continence experimentally in dogs. Its feasibility for perfect orientation as a neosphincter seems to be superior to any pedicled muscle flap. However, these preliminary results deserve further investigation prior to considering application in humans. PMID:17330203

Schwabegger, Anton H; Kronberger, Peter; Obrist, Peter; Brath, Endre; Miko, Iren

2007-02-01

262

Presynaptic Effects of Botulinum Toxin Type A on the Neuronally Evoked Response of Albino and Pigmented Rabbit Iris Sphincter and Dilator Muscles  

Microsoft Academic Search

Purpose: To investigate the effects of botulinum toxin type A (botulinum A toxin) on the autonomic and other nonadrenergic, noncholinergic nerve terminals.Methods: The effects of botulinum A toxin on twitch contractions evoked by electrical field stimulation (EFS) were studied in isolated albino and pigmented rabbit iris sphincter and dilator muscles using the isometric tension recording method.Results: Botulinum A toxin inhibited

Hitoshi Ishikawa; Yoshihisa Mitsui; Takeshi Yoshitomi; Kimiyo Mashimo; Shigeru Aoki; Kazuo Mukuno; Kimiya Shimizu

2000-01-01

263

Risk factors associated with anal sphincter tear: A comparison of primiparous patients, vaginal births after cesarean deliveries, and patients with previous vaginal delivery  

Microsoft Academic Search

Objective: This study was conducted to identify obstetric risk factors for anal sphincter tear in primiparous patients, patients with a previous cesarean delivery (VBAC), and patients with a previous vaginal delivery (PVD). Study Design: An obstetrics automated record system was accessed to retrospectively review records of all singleton vaginal deliveries at greater than 36 weeks' gestation (excluding breech and stillbirth)

Holly E. Richter; Cynthia G. Brumfield; Suzanne P. Cliver; Kathryn L. Burgio; Cherry L. Neely; R. Edward Varner

2002-01-01

264

Mitochondrial Dysfunction in Parkinson's Disease  

PubMed Central

Parkinson's disease (PD) is a progressive, neurodegenerative condition that has increasingly been linked with mitochondrial dysfunction and inhibition of the electron transport chain. This inhibition leads to the generation of reactive oxygen species and depletion of cellular energy levels, which can consequently cause cellular damage and death mediated by oxidative stress and excitotoxicity. A number of genes that have been shown to have links with inherited forms of PD encode mitochondrial proteins or proteins implicated in mitochondrial dysfunction, supporting the central involvement of mitochondria in PD. This involvement is corroborated by reports that environmental toxins that inhibit the mitochondrial respiratory chain have been shown to be associated with PD. This paper aims to illustrate the considerable body of evidence linking mitochondrial dysfunction with neuronal cell death in the substantia nigra pars compacta (SNpc) of PD patients and to highlight the important need for further research in this area. PMID:21461368

Keane, P. C.; Kurzawa, M.; Blain, P. G.; Morris, C. M.

2011-01-01

265

Sexual Dysfunction after Radical Prostatectomy  

PubMed Central

Sexual dysfunction associated with radical retropubic prostatectomy (RRP) may start before the surgery. Men undergoing RRP frequently have some degree of sexual dysfunction. In addition to the psychological stress of the diagnosis, the biopsy may itself have a detrimental effect. After surgery, all men will experience loss of ejaculate, because the organ responsible for ejaculate has been removed. Orgasm quality is adversely affected in many men. Erectile dysfunction is immediate and recovery from it is slow. Initially, phosphodiesterase (PDE)-5 inhibitors do not work, and they take up to 18 months for their effect to be maximized. Younger men who have had bilateral nerve-sparing procedures respond the best. Combination treatment with prostaglandin E1 or high-dose PDE-5 inhibitors may provide salvage therapy when initial PDE-5 inhibitor therapy has failed. PMID:16985895

McCullough, Andrew R

2005-01-01

266

[Diagnosis of neurogenic bladder dysfunction].  

PubMed

Patients with congenital and acquired neurogenic bladder dysfunction due to central and peripheral nervous lesions are significantly limited in their daily lives. The neurogenic dysfunction of the bladder and lower urinary tract are often misinterpreted and later fed to a diagnosis. Without therapy severe complications, including renal damage, could be the consequence in the follow up. Therefore, dedicated diagnostics have to be done to recognize the different disorders and to determine the specific therapy. For these patients a lifelong bladder monitoring and neuro-urological management is necessary. This article describes techniques of neuro-urological testings and the interpretation in case of neurogenic disorders. PMID:22331071

Kaufmann, A; Kurze, I

2012-02-01

267

Does stress induce bowel dysfunction?  

PubMed Central

Psychological stress is known to induce somatic symptoms. Classically, many gut physiological responses to stress are mediated by the hypothalamus-pituitary-adrenal axis. There is, however, a growing body of evidence of stress-induced corticotrophin-releasing factor (CRF) release causing bowel dysfunction through multiple pathways, either through the HPA axis, the autonomic nervous systems, or directly on the bowel itself. In addition, recent findings of CRF influencing the composition of gut microbiota lend support for the use of probiotics, antibiotics, and other microbiota-altering agents as potential therapeutic measures in stress-induced bowel dysfunction. PMID:24881644

Chang, Yu-Ming; El-Zaatari, Mohamad; Kao, John Y

2014-01-01

268

Damage to the innervation of the voluntary anal and periurethral sphincter musculature in incontinence: an electrophysiological study.  

PubMed Central

In 40 women with idiopathic (neurogenic) faecal incontinence, 20 of whom also had stress urinary incontinence, single fibre EMG studies showed an increased fibre density in the external anal sphincter muscle. All these patients showed excessive descent of the pelvic floor on straining. The mean terminal motor latencies in the pudendal and perineal nerves, measured by a digitally-directed intrarectal stimulating technique, were increased when compared with 20 control subjects (p less than 0.01). The perineal nerve terminal motor latency was more markedly increased in the 20 patients with double incontinence than in those with faecal incontinence alone (p less than 0.01). These results provide direct electrophysiological evidence of damage to the innervation of the pelvic floor musculature in idiopathic faecal and double incontinence, and imply that idiopathic stress urinary incontinence may have a similar cause. PMID:6512547

Snooks, S J; Barnes, P R; Swash, M

1984-01-01

269

Molecular and pharmacological characterization of a functional tachykinin NK3 receptor cloned from the rabbit iris sphincter muscle  

PubMed Central

A functional tachykinin NK3 receptor was cloned from the rabbit iris sphincter muscle and its distribution investigated in ocular tissues.Standard polymerase chain reaction (PCR) techniques were used to clone a full length rabbit NK3 receptor cDNA consisting of 1404 nucleotides. This cDNA encoded a protein of 467 amino acids with 91 and 87% homology to the human and rat NK3 receptors respectively.In CHO-K1 cells transiently expressing the recombinant rabbit NK3 receptor, the relative order of potency of NKB>>NKA?SP to displace [125I]-[MePhe7]-NKB binding and to increase intracellular calcium, together with the high affinity of NK3 selective agonists (e.g. senktide, [MePhe7]-NKB) and antagonists (e.g. SR?142801, SB?223412) in both assays was consistent with NK3 receptor pharmacology. In binding and functional experiments, agonist concentration response curves were shallow (0.7–0.8), suggesting the possibility of multiple affinity states of the receptor.Quantitative real time PCR analysis revealed highest expression of rabbit NK3 receptor mRNA in iris sphincter muscle, lower expression in retina and iris dilator muscle, and no expression in lens and cornea. In situ hybridization histochemistry revealed discrete specific localization of NK3 receptor mRNA in the iris muscle and associated ciliary processes. Discrete specific labelling of NK3 receptors with the selective NK3 receptor agonist [125I]-[MePhe7]-NKB was also observed in the ciliary processes using autoradiography.Our study reveals a high molecular similarity between rabbit and human NK3 receptor mRNAs, as predicted from previous pharmacological studies, and provide the first evidence that NK3 receptors are precisely located on ciliary processes in the rabbit eye. In addition, there could be two affinity states of the receptor which may correspond to the typical and ‘atypical' NK3 receptor subtypes previously reported. PMID:10516642

Medhurst, Andrew D; Hirst, Warren D; Jerman, Jeffery C; Meakin, Jacqueline; Roberts, Jennifer C; Testa, Tania; Smart, Darren

1999-01-01

270

Effect of chronic and acute cigarette smoking on the pharyngo-upper oesophageal sphincter contractile reflex and reflexive pharyngeal swallow  

PubMed Central

Background—Cigarette smoking is known to affect adversely the defence mechanisms against gastro-oesophageal reflux. The effect of smoking on the supraoesophageal reflexes that prevent aspiration of gastric contents has not been previously studied. ?Aims—To elucidate the effect of cigarette smoking on two of the supraoesophageal reflexes: the pharyngo-upper oesophageal sphincter (UOS) contractile reflex; and the reflexive pharyngeal swallow. ?Methods—Ten chronic smokers and 10 non-smokers were studied, before and 10 minutes after real or simulated smoking, respectively. UOS pressure and threshold volume for the reflexes were determined using a UOS sleeve assembly. Two modes of fluid delivery into the pharynx were tested: rapid injection and slow injection. ?Results—For both rapid and slow injections, the threshold volume for triggering the pharyngo-UOS contractile reflex was significantly higher in smokers than in non-smokers (rapid: smokers 0.42 (SE 0.07) ml, non-smokers 0.16 (0.04) ml; slow: smokers 0.86 (0.06) ml, non-smokers 0.38 (0.1) ml; p<0.05). During rapid injection, the threshold volume for reflexive pharyngeal swallow was higher in smokers (smokers 0.94 (0.09) ml, non-smokers 0.46 (0.05) ml; p<0.05). Acute smoking further increased the threshold volume for the pharyngo-UOS contractile reflex and reflexive pharyngeal swallow during rapid injection. ?Conclusions—Smoking adversely affects stimulation of the pharyngo-UOS contractile reflex and pharyngeal reflexive swallow. These findings may have implications in the development of reflux related respiratory complications among smokers. ?? Keywords: smoking; supraoesophageal reflexes; pharyngo-upper oesophageal sphincter contractile reflex; reflexive pharyngeal swallow; airway protection; gastro-oesophageal reflux PMID:9824582

Dua, K; Bardan, E; Ren, J; Sui, Z; Shaker, R

1998-01-01

271

Proteinase-activated receptor-1 (PAR1) and PAR2 mediate relaxation of guinea pig internal anal sphincter.  

PubMed

Activation of proteinase-activated receptor-1 (PAR1) and PAR2 stimulates contraction of the rat but relaxation of the guinea pig colon. The aim of the present study was to investigate PAR effects on internal anal sphincter (IAS) motility. We measured relaxation of isolated muscle strips from the guinea pig IAS caused by PAR agonists using isometric transducers. Reverse transcription polymerase chain reaction (RT-PCR) was performed to determine the existence of PAR. In the IAS, thrombin and PAR1 peptide agonists TFLLR-NH2 and SFLLRN-NH2 evoked moderate to marked relaxation in a concentration-dependent manner. In addition, trypsin and PAR2 peptide agonists 2-furoyl-LIGRLO-NH2, SLIGRL-NH2 and SLIGKV-NH2 produced relaxation. In contrast, both PAR1 and PAR2 inactive control peptides did not elicit relaxation. Furthermore, the selective PAR1 antagonist vorapaxar and PAR2 antagonist GB 83 specifically inhibited thrombin and trypsin-induced relaxations, respectively. RT-PCR revealed the presence of PAR1 and PAR2 in the IAS. This indicates that PAR1 and PAR2 mediate the IAS relaxation. The relaxant responses of TFLLR-NH2 and trypsin were attenuated by N(omega)-Nitro-L-arginine (L-NNA), indicating involvement of NO. These responses were not affected by tetrodotoxin, implying that the PAR effects are not neurally mediated. On the other hand, PAR4 agonists GYPGKF-NH2, GYPGQV-NH2 and AYPGKF-NH2 did not cause relaxation or contraction, suggesting that PAR4 is not involved in the sphincter motility. Taken together, these results demonstrate that both PAR1 and PAR2 mediate relaxation of the guinea pig IAS through the NO pathway. PAR1 and PAR2 may regulate IAS tone and might be potential therapeutic targets for anal motility disorders. PMID:24631471

Huang, Shih-Che

2014-02-10

272

Complications After Sphincter-Saving Resection in Rectal Cancer Patients According to Whether Chemoradiotherapy Is Performed Before or After Surgery  

SciTech Connect

Purpose: The aim of the present study was to compare the influence of preoperative chemoradiotherapy (CRT) with postoperative CRT on the incidence and types of postoperative complications in rectal cancer patients who underwent sphincter-saving resection. Patients and Methods: We reviewed 285 patients who received preoperative CRT and 418 patients who received postoperative CRT between January 2000 and December 2006. Results: There was no between-group difference in age, gender, or cancer stage. In the pre-CRT group, the mean level of anastomosis from the anal verge was lower (3.5 {+-} 1.4 cm vs. 4.3 {+-} 1.7 cm, p < 0.001) and the rate of T4 lesion and temporary diverting ileostomy was higher than in the post-CRT group. Delayed anastomotic leakage and rectovaginal fistulae developed more frequently in the pre-CRT group than in the post-CRT group (3.9% vs. 1.2%, p = 0.020, 6.5% vs. 1.3%, p = 0.027, respectively). Small bowel obstruction (arising from radiation enteritis) requiring surgical intervention was more frequent in the post-CRT group (0% in the pre-CRT group vs. 1.4% in the post-CRT group, p = 0.042). Multivariate analysis identified preoperative CRT as an independent risk factor for fistulous complications (delayed anastomotic leakage, rectovaginal fistula, rectovesical fistula), and postoperative CRT as a risk factor for obstructive complications (anastomotic stricture, small bowel obstruction). The stoma-free rates were significantly lower in the pre-CRT group than in the post-CRT group (5-year stoma-free rates: 92.8% vs. 97.0%, p = 0.008). Conclusion: The overall postoperative complication rates were similar between the pre-CRT and the Post-CRT groups. However, the pattern of postoperative complications seen after sphincter- saving resection differed with reference to the timing of CRT.

Kim, Chan Wook [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Kim, Jong Hoon [Department of Radiation Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Yu, Chang Sik, E-mail: csyu@amc.seoul.k [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Shin, Ui Sup; Park, Jin Seok; Jung, Kwang Yong [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Kim, Tae Won [Department of Medical Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Yoon, Sang Nam; Lim, Seok-Byung; Kim, Jin Cheon [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of)

2010-09-01

273

Bowel dysfunction after rectal cancer treatment: a study comparing the specialist's versus patient's perspective  

PubMed Central

Objectives To investigate how bowel dysfunction after sphincter-preserving rectal cancer treatment, known as low anterior resection syndrome (LARS), is perceived by rectal cancer specialists, in relation to the patient's experience. Design Questionnaire study. Setting International. Participants 58 rectal cancer specialists (45 colorectal surgeons and 13 radiation oncologists). Research procedure The Low Anterior Resection Syndrome Score (LARS score) is a five-item instrument for evaluation of LARS, which was developed from and validated on 961 patients. The 58 specialists individually completed two LARS score-based exercises. In Exercise 1, they were asked to select, from a list of bowel dysfunction issues, five items that they considered to disturb patients the most. In Exercise 2, they were given a list of scores to assign to the LARS score items, according to the impact on quality of life (QOL). Outcome measures In Exercise 1, the frequency of selection of each issue, particularly the five items included in the LARS score, was compared with the frequency of being selected at random. In Exercise 2, the answers were compared with the original patient-derived scores. Results Four of the five LARS score issues had the highest frequencies of selection (urgency, clustering, incontinence for liquid stool and frequency of bowel movements), which were also higher than random. However, the remaining LARS score issue (incontinence for flatus) showed a lower frequency than random. Scores assigned by the specialists were significantly different from the patient-derived scores (p<0.01). The specialists grossly overestimated the impact of incontinence for liquid stool and frequent bowel movements on QOL, while they markedly underestimated the impact of clustering and urgency. The results did not differ between surgeons and oncologists. Conclusions Rectal cancer specialists do not have a thorough understanding of which bowel dysfunction symptoms truly matter to the patient, nor how these symptoms affect QOL. PMID:24448844

Chen, Tina Yen-Ting; Emmertsen, Katrine J?ssing; Laurberg, S?ren

2014-01-01

274

Left Ventricular Dysfunction in Diabetes  

Microsoft Academic Search

Patients with diabetes mellitus have a greater morbidity and mortality from cardiovascular disease than patients without diabetes. Concomitant hypertension and diabetes are associated with even greater risk of coronary disease, atherosclerotic and peripheral vascular disease, and congestive heart failure. In addition, an independent left ventricular dysfunction (diabetic cardiomyopathy) exists in patients with diabetes that may manifest itself initially as abnormalities

Steven J. Lavine

1999-01-01

275

GABAergic dysfunction in mood disorders  

Microsoft Academic Search

The authors review the available literature on the preclinical and clinical studies involving GABAergic neurotransmission in mood disorders. ?-Aminobutyric acid (GABA) is an inhibitory neurotransmitter present almost exclusively in the central nervous system (CNS), distributed across almost all brain regions, and expressed in interneurons modulating local circuits. The role of GABAergic dysfunction in mood disorders was first proposed 20 years

P Brambilla; J Perez; F Barale; G Schettini; J C Soares

2003-01-01

276

Current Concepts in Ejaculatory Dysfunction  

PubMed Central

Although erectile dysfunction has recently become the most well-known aspect of male sexual dysfunction, the most prevalent male sexual disorders are ejaculatory dysfunctions. Ejaculatory disorders are divided into 4 categories: premature ejaculation (PE), delayed ejaculation, retrograde ejaculation, and anejaculation/anorgasmia. Pharmacologic treatment for certain ejaculatory disorders exists, for example the off-label use of selective serotonin reuptake inhibitors for PE. Unfortunately, the other ejaculatory disorders are less studied and not as well understood. This review revisits the physiology of the normal ejaculatory response, specifically explores the mechanisms of anejaculation, and presents emerging data. The neurophysiology of the ejaculatory reflex is complex, making classification of the role of individual neurotransmitters extremely difficult. However, recent research has elucidated more about the role of serotonin and dopamine at the central level in the physiology of both arousal and orgasm. Other recent studies that look at differing pharmacokinetic profiles and binding affinities of the ?1-antagonists serve as an indication of the centrally mediated role of ejaculation and orgasm. As our understanding of the interaction between central and peripheral modulations and regulation of the process of ejaculation increases, the probability of developing centrally acting pharmaceutical agents for the treatment of sexual dysfunction approaches reality. PMID:17215997

Wolters, Jeffrey P; Hellstrom, Wayne J. G

2006-01-01

277

JAMA Patient Page: Male Sexual Dysfunction  

MedlinePLUS

... call 718/946-7424. • Low libido (sexual interest) • Erectile dysfunction (ED, difficulty achieving or maintaining an erection) • Premature ... or discontinue the medication. • Prescription medications that treat erectile dysfunction may help a man achieve and maintain erections. • ...

278

Doppler echocardiographic changes found in diastolic dysfunction.  

PubMed

Diastolic dysfunction may be associated with increased morbidity and mortality. In this article, an overview of the pathophysiology of diastolic dysfunction is discussed and the findings of Doppler echocardiography used to aid in its diagnosis are reviewed. PMID:11877917

Kane, L S

2001-01-01

279

The CNS and bladder dysfunction  

PubMed Central

The brain's role in the development and maintenance of bladder control is critical, although its precise role in patient-reported complaints such as urgency and urine leakage is unknown. Functional brain imaging studies have advanced our knowledge of brain activity during the micturition cycle, showing multiple neuronal circuits involved as parts of a ‘brain-bladder control network.’ Yet, new advances need to be made in order to incorporate this knowledge into existing models of neuroanatomy and of clinical syndromes of bladder dysfunction and related clinical practice. This short article explains why and how brain imaging methods are poised to achieve that goal and decode the role of the brain in widely prevalent clinical conditions related to bladder dysfunction. PMID:23091564

Holstege, Gert; Griffiths, Derek J.

2012-01-01

280

Mitochondria: Redox Metabolism and Dysfunction  

PubMed Central

Mitochondria are the main intracellular location for fuel generation; however, they are not just power plants but involved in a range of other intracellular functions including regulation of redox homeostasis and cell fate. Dysfunction of mitochondria will result in oxidative stress which is one of the underlying causal factors for a variety of diseases including neurodegenerative diseases, diabetes, cardiovascular diseases, and cancer. In this paper, generation of reactive oxygen/nitrogen species (ROS/RNS) in the mitochondria, redox regulatory roles of certain mitochondrial proteins, and the impact on cell fate will be discussed. The current state of our understanding in mitochondrial dysfunction in pathological states and how we could target them for therapeutic purpose will also be briefly reviewed. PMID:22593827

Kang, Jia; Pervaiz, Shazib

2012-01-01

281

Synaptic dysfunction and intellectual disability.  

PubMed

Intellectual disability (ID) is a common and highly heterogeneous paediatric disorder with a very severe social impact. Intellectual disability can be caused by environmental and/or genetic factors. Although in the last two decades a number of genes have been discovered whose mutations cause mental retardation, we are still far from identifying the impact of these mutations on brain functions. Many of the genes mutated in ID code for several proteins with a variety of functions: chromatin remodelling, pre-/post-synaptic activity, and intracellular trafficking. The prevailing hypothesis suggests that the ID phenotype could emerge from abnormal cellular processing leading to pre- and/or post-synaptic dysfunction. In this chapter, we focus on the role of small GTPases and adhesion molecules, and we discuss the mechanisms through which they lead to synaptic network dysfunction. PMID:22351067

Valnegri, Pamela; Sala, Carlo; Passafaro, Maria

2012-01-01

282

Sleep dysfunction in heart failure  

Microsoft Academic Search

Opinion statement  Chronic congestive heart failure is a highly prevalent and progressive disorder associated with excess morbidity and mortality;\\u000a it has huge economic impact. Left heart failure may be systolic or may occur as isolated diastolic dysfunction. The diastolic\\u000a form predominates in older people. Sleep disorders are frequent in both types. Most systematic studies have been performed\\u000a in patients with systolic

Shahrokh Javaheri

2008-01-01

283

Insulin dysfunction and Tau pathology  

PubMed Central

The neuropathological hallmarks of Alzheimer's disease (AD) include senile plaques of ?-amyloid (A?) peptides (a cleavage product of the Amyloid Precursor Protein, or APP) and neurofibrillary tangles (NFT) of hyperphosphorylated Tau protein assembled in paired helical filaments (PHF). NFT pathology is important since it correlates with the degree of cognitive impairment in AD. Only a small proportion of AD is due to genetic variants, whereas the large majority of cases (~99%) is late onset and sporadic in origin. The cause of sporadic AD is likely to be multifactorial, with external factors interacting with biological or genetic susceptibilities to accelerate the manifestation of the disease. Insulin dysfunction, manifested by diabetes mellitus (DM) might be such factor, as there is extensive data from epidemiological studies suggesting that DM is associated with an increased relative risk for AD. Type 1 diabetes (T1DM) and type 2 diabetes (T2DM) are known to affect multiple cognitive functions in patients. In this context, understanding the effects of diabetes on Tau pathogenesis is important since Tau pathology show a strong relationship to dementia in AD, and to memory loss in normal aging and mild cognitive impairment. Here, we reviewed preclinical studies that link insulin dysfunction to Tau protein pathogenesis, one of the major pathological hallmarks of AD. We found more than 30 studies reporting Tau phosphorylation in a mouse or rat model of insulin dysfunction. We also payed attention to potential sources of artifacts, such as hypothermia and anesthesia, that were demonstrated to results in Tau hyperphosphorylation and could major confounding experimental factors. We found that very few studies reported the temperature of the animals, and only a handful did not use anesthesia. Overall, most published studies showed that insulin dysfunction can promote Tau hyperphosphorylation and pathology, both directly and indirectly, through hypothermia. PMID:24574966

El Khoury, Noura B.; Gratuze, Maud; Papon, Marie-Amelie; Bretteville, Alexis; Planel, Emmanuel

2013-01-01

284

Gastrointestinal dysfunction in liver cirrhosis  

PubMed Central

Patients with liver cirrhosis exhibit several features of gut dysfunction which may contribute to the development of cirrhosis complications as well as have an impact on nutritional status and health-related quality of life. Gastrointestinal symptoms are common in cirrhosis and their pathophysiology probably involves factors related to liver disease severity, psychological distress, and gut dysfunction (e.g., increased gastric sensitivity to distension and delayed gut transit). They may lead to reduced food intake and, thus, may contribute to the nutritional status deterioration in cirrhotic patients. Although tense ascites appears to have a negative impact on meal-induced accommodation of the stomach, published data on gastric accommodation in cirrhotics without significant ascites are not unanimous. Gastric emptying and small bowel transit have generally been shown to be prolonged. This may be related to disturbances in postprandial glucose, insulin, and ghrelin levels, which, in turn, appear to be associated to insulin resistance, a common finding in cirrhosis. Furthermore, small bowel manometry disturbances and delayed gut transit may be associated with the development of small bowel bacterial overgrowth. Finally, several studies have reported intestinal barrier dysfunction in patients with cirrhosis (especially those with portal hypertension), which is related to bacterial translocation and permeation of intestinal bacterial products, e.g., endotoxin and bacterial DNA, thus potentially being involved in the pathogenesis of complications of liver cirrhosis. PMID:25356031

Kalaitzakis, Evangelos

2014-01-01

285

Effects of Age, Gender, Bolus Condition, Viscosity, and Volume on Pharyngeal and Upper Esophageal Sphincter Pressure and Temporal Measurements during Swallowing  

ERIC Educational Resources Information Center

Purpose: The purpose of this study was to determine the effects of trial (i.e., Trial 1 vs. Trial 2); viscosity (i.e., saliva, thin, nectar-thick, honey-thick, and pudding-thick water); volume (i.e., 5 mL vs. 10 mL); age (i.e., young vs. older adults); and gender on pharyngeal (i.e., upper and lower) and upper esophageal sphincter (UES) pressures,…

Butler, Susan G.; Stuart, Andrew; Castell, Donald; Russell, Gregory B.; Koch, Kenneth; Kemp, Shannon

2009-01-01

286

The trans-sphincteric posterior sagittal repair of recto-urinary and recto-vaginal fistulae using Surgisis™ mesh and fibrin sealant.  

PubMed

Recto-urinary, recto-vaginal and ileo-anal pouch-associated fistulae are rare yet a significant clinical problem due to their profound impact on patients' quality of life and are a challenge to repair. In this report, we describe repair of these complex fistulae using a modified trans-sphincteric posterior sagittal approach with Surgisis™ mesh and fibrin sealant and review our repair outcomes. PMID:23095950

Borowiec, A M; McCall, M; Lees, G M

2014-02-01

287

Dosimetric Coverage of the External Anal Sphincter by 3-Dimensional Conformal Fields in Rectal Cancer Patients Receiving Neoadjuvant Chemoradiation: Implications for the Concept of Sphincter-Preserving Radiation Therapy  

PubMed Central

Background. We evaluated the anatomic location of the external anal sphincter (EAS) to pelvic bony landmarks related to 3-dimensional conformal radiotherapy (3DRT) and studied the dosimetric coverage of the EAS in patients undergoing neoadjuvant chemoradiation for rectal cancer. Methods. Sixty-four consecutive rectal cancer patients treated with neoadjuvant chemoradiation were included. All patients were treated in a prone position on a bellyboard by 3DRT. The inferior border of the RT fields was at least 3–5?cm inferior to the gross tumorous volume (GTV) or at the inferior border of the obturator foramen (IBOF), whichever was more inferior. The EAS was contoured and dose distributions were determined using dose-volume histograms. Results. In 53 out of 64 cases (82.8%), the EAS was completely inferior to the IBOF. In the remaining 11 cases, the EAS was either overlapping the IBOF (10 cases; 15.6%) or completely superior to the IBOF (1 case; 1.7%). The average mean dose delivered to the EAS was 2795?cGy. Lower mean doses were delivered to the EAS when the center of the EAS was located more distant from the GTV. Conclusions. Meticulous planning to define the inferior border of the RT field is recommended to avoid irradiating the EAS. PMID:25089274

Chen, Michelle B.; Liu, Alan J.; Tsai, Peter

2014-01-01

288

Quantifying Contributions of the Cricopharyngeus to Upper Esophageal Sphincter Pressure Changes by Means of Intramuscular Electromyography and High-Resolution Manometry  

PubMed Central

Objectives We sought to determine whether the association between cricopharyngeus muscle activity and upper esophageal sphincter pressure may change in a task-dependent fashion. We hypothesized that more automated tasks related to swallow or airway protection would yield a stronger association than would more volitional tasks related to tidal breathing or voice production. Methods Six healthy adult subjects underwent simultaneous intramuscular electromyography of the cricopharyngeus muscle and high-resolution manometry of the upper esophageal sphincter. Correlation coefficients were calculated to characterize the association between the time-linked series. Results Cricopharyngeus muscle activity was most strongly associated with upper esophageal sphincter pressure during swallow and effortful exhalation tasks (r = 0.77 and 0.79, respectively; P < .01). The association was also less variable during swallow and effortful exhalation. Conclusions These findings suggest a greater coupling for the more automatic tasks, and may suggest less coupling and more flexibility for the more volitional, voice-related tasks. These findings support the important role of central patterning for respiratory- and swallow-related tasks. PMID:24633943

Jones, Corinne A.; Hammer, Michael J.; Hoffman, Matthew R.; McCulloch, Timothy M.

2014-01-01

289

Asthma: vocal cord dysfunction (VCD) and other dysfunctional breathing disorders.  

PubMed

Vocal cord dysfunction (VCD) and dysfunctional breathing (DB) disorders may mimic or coexist with asthma, leading to overtreatment with corticosteroids with consequent morbidity. Iatrogenic complications can be averted by early and correct diagnosis. VCD, also termed paradoxical vocal fold motion disorder (PVFMD), is characterized by intermittent paradoxical adduction of the vocal cords, mainly during inspiration, leading to airflow obstruction and dyspnea. Patients with VCD may have repetitive emergency room visits due to acute dyspnea (mimicking exacerbations of asthma). In the seminal descriptions of VCD, young women (often with psychiatric issues) predominated; however, other groups at increased risk for developing VCD include elite athletes, military recruits, and individuals exposed to irritants (inhaled or aspirated). Chronic postnasal drip, laryngopharyngeal reflux (LPR), and gastroesophageal reflux (GER) may lead to laryngeal hyperresponsiveness. The diagnosis of VCD may be difficult because physical exam and spirometry may be normal between episodes. During symptomatic episodes, spirometry typically reveals variable extrathoracic airway obstruction (truncated inspiratory flow volume loop). The gold standard for identifying VCD is flexible fiberoptic rhinolaryngoscopy. Management of VCD includes identification and treatment of underlying disorders (eg, chronic postnasal drip, LPR, GER, anxiety, depression) and a multidisciplinary approach (including highly trained speech therapists). Speech therapy and biofeedback play a critical role in teaching techniques to override various dysfunctional breathing habits. When postnasal drip, LPR, or GER coexist, these disorders should be aggressively treated. With successful therapy, corticosteroids can often be discontinued. During severe, acute episodes of VCD, therapeutic strategies include heliox (80% helium/20% oxygen), topical lidocaine, anxiolytics, and superior laryngeal blocks with Clostridium botulinum toxin. DB is a poorly understood disorder with features that overlap with VCD and asthma. The dysfunctional pattern may reflect abnormalities in the rate or depth of breathing or in breathing mechanics that may involve the nasal passages, oropharynx, larynx, or chest wall muscles. Not unlike VCD, patients with DB are often diagnosed with asthma, and their symptoms do not improve on asthma medicines. There is no consensus regarding diagnostic criteria or appropriate testing for DB. The pathophysiology of DB is poorly understood, but psychological or physiological stress may precipitate episodes in some patients. Treatment requires a multidisciplinary approach (including speech therapy and psychological support). Prognosis is usually good. PMID:23047311

Balkissoon, Ron; Kenn, Klaus

2012-12-01

290

Pharmacotherapy of Sexual Dysfunctions : Current Status  

PubMed Central

The sexual dysfunctions are one of the most prevalent conditions. Sexual dysfunctions can have profound effect on the psychological well-being of an individual and the psychosexual relationship of a couple. Management of the sexual dysfunction should be preceded by an accurate diagnosis reached after a complete medical and sexual history and physical examination. Current focus of researchers has been on understanding the pathophysiology of erectile dysfunction, premature ejaculation and other sexual dysfunctions that can help in developing newer pharmacological cures for these conditions. Recently, a number of clinical trials have studied the potential effectiveness of the phosphodiesterase (PDE)-5 inhibitor sildenafil in the treatment of Erectile Dysfunction (ED) and Premature Ejaculation (PME). The introduction of PDE-5 inhibitors like sildenafil, vardenafil and tadalafil has revolutionized the treatment of sexual dysfunctions. This review focuses on the recent pharmacological advances in the treatment of common sexual dysfunctions like ED and PME with special focus on the role of PDE-5 inhibitors. Also discussed is the pharmacological treatment of other less prevalent and recognized disorders like female sexual dysfunction, drug induced sexual dysfunction etc. PMID:21224902

Avasthi, Ajith; Biswas, Parthasarathy

2004-01-01

291

Magnetic Sphincter Augmentation with the LINX Device for Gastroesophageal Reflux Disease after U.S. Food and Drug Administration Approval.  

PubMed

Magnetic sphincter augmentation (MSA) of the gastroesophageal junction with the LINX Reflux Management System is an alternative to fundoplication for gastroesophageal reflux disease (GERD) that was approved by the U.S. Food and Drug Administration (FDA) in March 2012. This is a prospective observational study of all patients who underwent placement of the LINX at two institutions from April 2012 to December 2013 to evaluate our clinical experience with the LINX device after FDA approval. There were no intraoperative complications and only four mild postoperative morbidities: three urinary retentions and one readmission for dehydration. The mean operative time was 60 minutes (range, 31 to 159 minutes) and mean length of stay was 11 hours (range, 5 to 35 hours). GERD health-related quality-of-life scores were available for 83 per cent of patients with a median follow-up of five months (range, 3 to 14 months) and a median score of four (range, 0 to 26). A total of 76.9 per cent of patients were no longer taking proton pump inhibitors. The most common postoperative complaint was dysphagia, which resolved in 79.1 per cent of patients with a median time to resolution of eight weeks. There were eight patients with persistent dysphagia that required balloon dilation with improvement in symptoms. MSA with LINX is a safe and effective alternative to fundoplication for treatment of GERD. The most common postoperative complaint is mild to moderate dysphagia, which usually resolves within 12 weeks. PMID:25264655

Reynolds, Jessica L; Zehetner, Joerg; Bildzukewicz, Nikolai; Katkhouda, Namir; Dandekar, Giovanni; Lipham, John C

2014-10-01

292

Endothelial dysfunction in diabetes mellitus  

PubMed Central

Diabetes mellitus is associated with an increased risk of cardiovascular disease, even in the presence of intensive glycemic control. Substantial clinical and experimental evidence suggest that both diabetes and insulin resistance cause a combination of endothelial dysfunctions, which may diminish the anti-atherogenic role of the vascular endothelium. Both insulin resistance and endothelial dysfunction appear to precede the development of overt hyperglycemia in patients with type 2 diabetes. Therefore, in patients with diabetes or insulin resistance, endothelial dysfunction may be a critical early target for preventing atherosclerosis and cardiovascular disease. Microalbuminuria is now considered to be an atherosclerotic risk factor and predicts future cardiovascular disease risk in diabetic patients, in elderly patients, as well as in the general population. It has been implicated as an independent risk factor for cardiovascular disease and premature cardiovascular mortality for patients with type 1 and type 2 diabetes mellitus, as well as for patients with essential hypertension. A complete biochemical understanding of the mechanisms by which hyperglycemia causes vascular functional and structural changes associated with the diabetic milieu still eludes us. In recent years, the numerous biochemical and metabolic pathways postulated to have a causal role in the pathogenesis of diabetic vascular disease have been distilled into several unifying hypotheses. The role of chronic hyperglycemia in the development of diabetic microvascular complications and in neuropathy has been clearly established. However, the biochemical or cellular links between elevated blood glucose levels, and the vascular lesions remain incompletely understood. A number of trials have demonstrated that statins therapy as well as angiotensin converting enzyme inhibitors is associated with improvements in endothelial function in diabetes. Although antioxidants provide short-term improvement of endothelial function in humans, all studies of the effectiveness of preventive antioxidant therapy have been disappointing. Control of hyperglycemia thus remains the best way to improve endothelial function and to prevent atherosclerosis and other cardiovascular complications of diabetes. In the present review we provide the up to date details on this subject. PMID:18200806

Hadi, Hadi AR; Suwaidi, Jassim Al

2007-01-01

293

Long-term outcomes of urinary tract reconstruction in patients with neurogenic urinary tract dysfunction  

PubMed Central

The advent of specialized spinal units and better understanding of the pathophysiology of neurogenic urinary tract dysfunction has made long-term survival of these patients a reality. This has, in turn, led to an increase in quality and choice of management modalities offered to these patients including complex anatomic urinary tract reconstructive procedures tailored to the unique needs of each individual with variable outcomes. We performed a literature review evaluating the long-term outcomes of these reconstructive procedures. To achieve this, we conducted a world-wide electronic literature search of long-term outcomes published in English. As the premise of this review is long-term outcomes, we have focused on pathologies where evidence of long-term outcome is available such as patients with spinal injuries and spina bifida. Therapeutic success following urinary tract reconstruction is usually measured by preservation of renal function, improvement in quality-of-life, the satisfactory achievement of agreed outcomes and the prevention of serious complications. Prognostic factors include neuropathic detrusor overactivity; sphincter dyssynergia; bladder over distension; high pressure storage and high leak point pressures; vesicoureteric reflex, stone formation and urinary tract infections. Although, the past decade has witnessed a reduction in the total number of bladder reconstructive surgeries in the UK, these procedures are essentially safe and effective; but require long-term clinical and functional follow-up/monitoring. Until tissue engineering and gene therapy becomes more mainstream, we feel there is still a place for urinary tract reconstruction in patients with neurogenic lower urinary tract dysfunction. PMID:24235796

Johnson, E. U.; Singh, Gurpreet

2013-01-01

294

Equine pituitary pars intermedia dysfunction.  

PubMed

Equine pituitary pars intermedia dysfunction (PPID), also known as equine Cushing's syndrome, is a widely recognized disease of aged horses. Over the past two decades, the aged horse population has expanded significantly and in addition, client awareness of PPID has increased. As a result, there has been an increase in both diagnostic testing and treatment of the disease. This review focuses on the pathophysiology and clinical syndrome, as well as advances in diagnostic testing and treatment of PPID, with an emphasis on those findings that are new since the excellent comprehensive review by Schott in 2002. PMID:21392656

McFarlane, Dianne

2011-04-01

295

Gluten-related neurologic dysfunction.  

PubMed

The term gluten-related disorders (GRD) encompasses a spectrum of systemic autoimmune diseases with diverse manifestations. GRD are characterized by abnormal immunological responsiveness to ingested gluten in genetically susceptible individuals. Celiac disease (CD) or gluten-sensitive enteropathy is only one of a number of GRD. Extraintestinal manifestations include dermatitis herpetiformis (DH) and neurologic dysfunction. Furthermore it is only recently that the concept of extraintestinal manifestations without enteropathy has become accepted. In this chapter we review the spectrum of neurologic manifestations in GRD, discuss recent advances in their diagnosis, and look at their possible pathophysiologic mechanisms. PMID:24365341

Hadjivassiliou, Marios; Duker, Andrew P; Sanders, David S

2014-01-01

296

Social support and psychosocial dysfunction in depression.  

PubMed

Influence of social support on psychosocial dysfunction was studied in fifty newly diagnosed patients with major depression, using Social Support Scale (SSS) and Dysfunctional Analysis Questionnaire (DAQ) to measure social support and psychosocial dysfunction respectively. Total score on SSS did not affect the dysfunction. A positive relationship was observed between items of SSS relating to care, concern and expectations from others and negative relationship observed between SSS items referring to socialization and dysfunction in social and familial areas. The relationship of social support and psychosocial dysfunction appears quite complex with certain elements of social support having a healthy and others having an unhealthy relationship. Since measurement of social support itself is accompanied by a number of methodological problems such as distorted perceptions of psychiatric patients about social support, this makes the relationship more complex. PMID:21743731

Chadda, R K

1995-07-01

297

DNA Damage Foci at Dysfunctional Telomeres  

Microsoft Academic Search

We report cytologic and genetic data indicating that telomere dysfunction induces a DNA damage response in mammalian cells. Dysfunctional, uncapped telomeres, created through inhibition of TRF2, became associated with DNA damage response factors, such as 53BP1, ?-H2AX, Rad17, ATM, and Mre11. We refer to the domain of telomere-associated DNA damage factors as a Telomere Dysfunction-Induced Focus (TIF). The accumulation of

Hiroyuki Takai; Agata Smogorzewska; Titia de Lange

2003-01-01

298

Biofeedback Therapy for Dysfunctional Voiding in Children  

Microsoft Academic Search

The past decade has seen a dramatic shift in the management of lower urinary tract dysfunction, including dysfunctional voiding,\\u000a in children. Once treated primarily with medication, dysfunctional voiding now is managed successfully in most cases with\\u000a noninvasive evaluations and biofeedback-based pelvic floor muscle retraining. Introduced in 1979, biofeedback initially was\\u000a expensive and labor intensive, requiring inpatient treatment. The use of

Joel F. Koenig; Patrick H. McKenna

2011-01-01

299

Mitochondrial dysfunction in heart failure  

PubMed Central

Heart failure (HF) is a complex chronic clinical syndrome. Energy deficit is considered to be a key contributor to the development of both cardiac and skeletal myopathy. In HF several components of cardiac and skeletal muscle bioenergetics are altered, such as oxygen availability, substrate oxidation, mitochondrial ATP production, and ATP transfer to the contractile apparatus via the creatine kinase shuttle. This review focuses on alterations in mitochondrial biogenesis and respirasome organization, substrate oxidation coupled with ATP synthesis in the context of their contribution to the chronic energy deficit, and mechanical dysfunction of the cardiac and skeletal muscle in HF. We conclude that HF is associated with decreased mitochondrial biogenesis and function in both heart and skeletal muscle, supporting the concept of a systemic mitochondrial cytopathy. The sites of mitochondrial defects are located within the electron transport and phosphorylation apparatus, and differ with the etiology and progression of HF in the two mitochondrial populations (subsarcolemmal and interfibrillar) of cardiac and skeletal muscle. The roles of adrenergic stimulation, the renin-angiotensin system, and cytokines are evaluated as factors responsible for the systemic energy deficit. We propose a cylic AMP-mediated mechanism by which increased adrenergic stimulation contributes to the mitochondrial dysfunction. PMID:22948484

Rosca, Mariana G.; Hoppel, Charles L.

2013-01-01

300

Multiple sclerosis and sexual dysfunction  

PubMed Central

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system characterized by episodic and progressive neurologic dysfunction resulting from inflammatory and autoimmune reactions. The underlying pathogenesis of MS remains largely unclear. However, it is currently accepted as a T cell-mediated autoimmune disease. Among other clinical manifestations, sexual dysfunction (SD) is a painful but still underreported and underdiagnosed symptom of the disorder. SD in MS patients may result from a complex set of conditions and may be associated with multiple anatomic, physiologic, biologic, medical and psychological factors. SD arises primarily from lesions affecting the neural pathways involved in physiologic function. In addition, psychological factors, the side effects of medications and physical symptoms such as fatigue, muscular weakness, menstrual changes, pain and concerns about bladder and bowel incontinence may also be involved. Since MS primarily affects young people, SD secondary to MS may have a great impact on quality of life. Thus, maintaining a healthy sexual life with MS is an important priority. The treatment of SD requires multidisciplinary teamwork and cooperation among specialists, individual patients, partners and the society. PMID:22447199

Guo, Zhen-Ni; He, Si-Yuan; Zhang, Hong-Liang; Wu, Jiang; Yang, Yi

2012-01-01

301

[Coronary microvascular dysfunction. An update].  

PubMed

Several studies in the last years have shown that a dysfunction of coronary microcirculation may be responsible for abnormalities in coronary blood flow and some clinical pictures. Coronary microvascular dysfunction, in absence of other coronary artery abnormalities, can cause anginal symptoms, resulting in a condition named microvascular angina (MVA). MVA can occur in a chronic form, predominantly related to effort (stable MVA), more frequently referred as cardiac syndrome X, or in an acute form, most frequently ensuing at rest, which simulates an acute coronary syndrome (unstable MVA). The main abnormalities characterizing these two forms of MVA consist of an impaired vasodilation and an increased vasoconstriction of small resistive coronary arteries, respectively. The mechanisms responsible for stable MVA are still unclear, but seem to include, together with the known traditional cardiovascular risk factors, an abnormally increased cardiac adrenergic activity. The prognosis of stable MVA is good, but some patients have progressive worsening of symptoms. Clinical outcome of patients with unstable MVA is substantially unknown, as there are no specific studies about this population. Treatment of stable MVA includes traditional anti-ischemic drugs as first step; in case of persisting symptoms several other drugs have been proposed, including xanthine derivatives, ACE-inhibitors, statins and, in women, estrogens. Severe forms of intense constriction (or spasm) of small coronary arteries may cause transmural myocardial ischemia, as the microvascular form of variant angina and the tako-tsubo syndrome. PMID:21947187

Lamendola, Priscilla; Di Franco, Antonino; Tarzia, Pierpaolo; Milo, Maria; Laurito, Marianna; Lanza, Gaetano A

2011-09-01

302

TREK-1 channels do not mediate nitrergic neurotransmission in circular smooth muscle from the lower oesophageal sphincter  

PubMed Central

Background and purpose: The ionic mechanisms underlying nitrergic inhibitory junction potentials (IJPs) in gut smooth muscle remain a matter of debate. Recently, it has been reported that opening of TWIK-related K+ channel 1 (TREK-1) K+ channels contributes to the nitrergic IJP in colonic smooth muscle. We investigated the effects of TREK-1 channel blockers on nitrergic neurotransmission in mouse and opossum lower oesophageal sphincter (LOS) circular smooth muscle (CSM). Experimental approach: The effects of TREK-1 channel blockers were characterized pharmacologically in murine and opossum gut smooth muscle using conventional intracellular and tension recordings. Key results: In LOS, L-methionine depolarized the resting membrane potential (RMP) but did not inhibit the nitrergic IJP. Cumulative application of theophylline hyperpolarized the RMP and inhibited the nitrergic IJP concentration dependently. The induced membrane hyperpolarization was prevented by pre-application of caffeine, but not by 1H-[1,2,4]oxadiazolo-[4,3-a]quinoxalin-1-one. 8-Br-cAMP significantly hyperpolarized membrane potential and increased the amplitude of the nitrergic IJP. In opossum LOS muscle strips, L-methionine increased resting tone but had no effect on nerve-mediated LOS relaxation. On the other hand, theophylline markedly inhibited tone. In CSM from mouse proximal colon, L-methionine caused modest inhibition of nitrergic IJPs. Conclusions and implications: TREK-1 channels were not involved in the nitrergic IJP in LOS CSM. Not only does L-methionine have no effect on the nitrergic IJP or LOS relaxation, but the effect of theophylline appears to be due to interruption of Ca2+-releasing pathways (i.e. caffeine-like effect) rather than via blockade of TREK-1 channels. PMID:20002101

Zhang, Y; Miller, DV; Paterson, WG

2010-01-01

303

Arachidonic acid metabolites follow the preferential course of cyclooxygenase pathway for the basal tone in the internal anal sphincter  

PubMed Central

Present studies determined the roles of the cyclooxygenase (COX) versus the lipoxygenase (LO) pathways in the metabolic pathway of arachidonic acid (AA) in the internal anal sphincter (IAS) tone. Studies were performed in the rat IAS versus the nontonic rectal smooth muscle (RSM). Indomethacin, the dual COX inhibitor, but not nordihydroguaiaretic acid (NDGA), the LO inhibitor, produced a precipitous decrease in the IAS tone. However, when added in the background of indomethacin, NDGA caused significant reversal of the IAS tone. These inhibitors had no significant effect on the RSM. To follow the significance of COX versus LO pathways, we examined the effects of AA and its metabolites. In the IAS, AA caused an increase in the IAS tone (Emax = 38.8 ± 3.0% and pEC50 = 3.4 ± 0.1). In the RSM, AA was significantly less efficacious and potent (Emax = 11.3 ± 3.5% and pEC50 = 2.2 ± 0.3). The AA metabolites (via COXs) PGF2? and U-46619 (a stable analog of thromboxane A2) produced increases in the IAS tone and force in the RSM. Conversely, AA metabolites (via 5-LO) lipoxin A4, 5-HETE, and leukotriene C4 decreased the IAS tone. Finally, the contractile effects of AA in the IAS were selectively attenuated by the COX-1 but not the COX-2 inhibitor. Collectively, the specific effects of AA and the COX inhibitor, the Western blot and RT-PCR analyses showing specifically higher levels of COX-1, suggest a preferential role of the COX (specifically COX-1) pathway versus the LO in the regulation of the IAS tone. PMID:19221012

de Godoy, Marcio A. F.; Rattan, Neeru; Rattan, Satish

2009-01-01

304

Arachidonic acid metabolites follow the preferential course of cyclooxygenase pathway for the basal tone in the internal anal sphincter.  

PubMed

Present studies determined the roles of the cyclooxygenase (COX) versus the lipoxygenase (LO) pathways in the metabolic pathway of arachidonic acid (AA) in the internal anal sphincter (IAS) tone. Studies were performed in the rat IAS versus the nontonic rectal smooth muscle (RSM). Indomethacin, the dual COX inhibitor, but not nordihydroguaiaretic acid (NDGA), the LO inhibitor, produced a precipitous decrease in the IAS tone. However, when added in the background of indomethacin, NDGA caused significant reversal of the IAS tone. These inhibitors had no significant effect on the RSM. To follow the significance of COX versus LO pathways, we examined the effects of AA and its metabolites. In the IAS, AA caused an increase in the IAS tone (Emax=38.8+/-3.0% and pEC50=3.4+/-0.1). In the RSM, AA was significantly less efficacious and potent (Emax=11.3+/-3.5% and pEC50=2.2+/-0.3). The AA metabolites (via COXs) PGF2alpha and U-46619 (a stable analog of thromboxane A2) produced increases in the IAS tone and force in the RSM. Conversely, AA metabolites (via 5-LO) lipoxin A4, 5-HETE, and leukotriene C4 decreased the IAS tone. Finally, the contractile effects of AA in the IAS were selectively attenuated by the COX-1 but not the COX-2 inhibitor. Collectively, the specific effects of AA and the COX inhibitor, the Western blot and RT-PCR analyses showing specifically higher levels of COX-1, suggest a preferential role of the COX (specifically COX-1) pathway versus the LO in the regulation of the IAS tone. PMID:19221012

de Godoy, Márcio A F; Rattan, Neeru; Rattan, Satish

2009-04-01

305

Long-term Outcome of the Readjustable Sling Procedure for Female Stress Urinary Incontinence With Intrinsic Sphincter Deficiency or Recurrence  

PubMed Central

Purpose We evaluated the long-term outcome of a readjustable midurethral sling system (Remeex) in the treatment of recurrence of stress urinary incontinence (SUI) after surgical treatment or SUI with intrinsic sphincter deficiency (ISD). Materials and Methods This study included 19 patients who underwent the Remeex procedure with a mean of 45.6 months of follow-up. The patients had responded to a telephone questionnaire. Thirteen patients had ISD, four patients had SUI recurrence, and two patients had both. The questionnaire included subjective cure and satisfaction surveys and also recommended surgery to some patients. Results The mean patient age was 69.1 years (range, 50-85 years), the mean parity was 2.79 times (range, 2-5 times), and the mean follow-up period was 45.6 months (range, 21-72 months). The long-term follow-up cure rate was 79%, the improvement rate was 21%, and the fail rate was 0%. The long-term follow-up "very satisfactory" rate was 26.3%, the "satisfactory" rate was 73.7%, and the "usual" and "unsatisfactory" rates were both 0%. In addition to these results, 16 patients (84.2%) would recommend the Remeex procedure to other patients with SUI recurrence or ISD. After the procedure, four patients had urinary retention, three patients had difficulty emptying, and one patient had SUI recurrence. Furthermore, all of the patients subsequently endured sling readjustments. Conclusions After long-term follow-up, the Remeex system showed good cure rates and subjective satisfaction rates that were similar to the results found at the 1-year follow-up, and minimal complications were reported. Therefore, the Remeex system is effective in treating patients with SUI recurrence or ISD. PMID:24578809

Seo, Mu Yeal

2014-01-01

306

Chronic renal dysfunction late after liver transplantation  

Microsoft Academic Search

With the increasing success of liver transplantation, more patients are developing late complications such as renal dysfunction. The goal of the current study was to assess the prevalence of renal dysfunction years after liver transplantation and to identify patients at risk for the development of this complication. Of the 527 liver transplantations performed at our institution between April 1990 and

Ari J. Cohen; Mark D. Stegall; Charles B. Rosen; Russell H. Wiesner; Nelson Leung; Walter K. Kremers; Nizar N. Zein

2002-01-01

307

Epidemiology and pathophysiology of male sexual dysfunction  

Microsoft Academic Search

Male sexual dysfunction (MSD) is a common disorder associated with a wide range of physical and psychological conditions. Erectile dysfunction, the most commonly studied aspect of MSD, is common and increases with age and with certain comorbid conditions. The pathophysiology of ED and other forms of MSD can be traced to a variety of etiologies, including vascular, hormonal, psychiatric, iatrogenic

J Kaminetsky

2008-01-01

308

On the Etiology of Sexual Dysfunction  

ERIC Educational Resources Information Center

Lack of consideration of the sexually functional population has led to misconceptions about causes of sexual dysfunction functioning. Automatic functioning can mask effects of pathogenic influences on sexuality, making these effects appear random, confounding etiological issues and creating the belief that causes of sexual dysfunction and disorder…

Apfelbaum, Bernard

1977-01-01

309

Male Pseudoheterosexuality and Minimal Sexual Dysfunction  

ERIC Educational Resources Information Center

There is often a correlation between "pseudoheterosexuality" and minor sexual dysfunction. Insight alone is not sufficient to provide relief, but when the patient can be helped to a comfortable acceptance of his homosexual feelings as a normal and healthy facet of his personality, very often the dysfunction is relieved. (Author)

Gutstadt, Joseph P.

1976-01-01

310

Terbinafine-induced hepatic dysfunction.  

PubMed

A 41-year-old man developed severe hepatic dysfunction following a 3.5-week course of terbinafine (250 mg/day). He suffered marked pruritus, jaundice, malaise, anorexia and loin pain. Serum bilirubin rose to a peak value of 718 micromol/l with alkaline phosphatase at 569 U/l, alanine aminotransferase at 90 U/l, aspartate aminotransferase at 63 U/l and a prolonged prothrombin time of 21 s, unresponsive to vitamin K. Transjugular liver biopsy showed canalicular cholestasis consistent with a drug reaction. Symptoms resolved 11 months after drug cessation, with liver function tests returning to normal values after 15 months. This case represents the most severe cholestatic reaction reported to date, resulting in patient recovery without liver transplantation. A comprehensive literature review is provided. PMID:11564966

Chambers, W M; Millar, A; Jain, S; Burroughs, A K

2001-09-01

311

Auditory Dysfunction in Patients with Cerebrovascular Disease  

PubMed Central

Auditory dysfunction is a common clinical symptom that can induce profound effects on the quality of life of those affected. Cerebrovascular disease (CVD) is the most prevalent neurological disorder today, but it has generally been considered a rare cause of auditory dysfunction. However, a substantial proportion of patients with stroke might have auditory dysfunction that has been underestimated due to difficulties with evaluation. The present study reviews relationships between auditory dysfunction and types of CVD including cerebral infarction, intracerebral hemorrhage, subarachnoid hemorrhage, cerebrovascular malformation, moyamoya disease, and superficial siderosis. Recent advances in the etiology, anatomy, and strategies to diagnose and treat these conditions are described. The numbers of patients with CVD accompanied by auditory dysfunction will increase as the population ages. Cerebrovascular diseases often include the auditory system, resulting in various types of auditory dysfunctions, such as unilateral or bilateral deafness, cortical deafness, pure word deafness, auditory agnosia, and auditory hallucinations, some of which are subtle and can only be detected by precise psychoacoustic and electrophysiological testing. The contribution of CVD to auditory dysfunction needs to be understood because CVD can be fatal if overlooked.

2014-01-01

312

Role of Lipotoxicity in Endothelial Dysfunction  

PubMed Central

SUMMARY Lipotoxicity, caused in large part by overnutrition, directly leads to endothelial dysfunction. Excess lipids in both the circulation and at the tissue level contribute to endothelial dysfunction that underlies much of the pathophysiology of both metabolic disease, including obesity and diabetes and their CV complications. Direct lipotoxic effects on other organs as well as secondary insults from endothelial dysfunction synergize to cause substantial morbidity and mortality. Lifestyle interventions, including reduced calorie intake, diet, and exercise as well as a variety of pharmacologic interventions targeting various mechanisms underlying lipotoxicity in vascular endothelium significantly modify metabolic and CV risk. PMID:22999242

Kim, Jeong-a; Montagnani, Monica; Chandrasekran, Sruti; Quon, Michael J.

2014-01-01

313

Sexual dysfunction within an adult developmental perspective.  

PubMed

The focus of this paper is on the adult who has adequately mastered the oedipal stage of psychosexual development and who presents with a sexual dysfunction. Drawing on the developmental sequence of Erik Erikson, the authors suggest that failure to address adequately an adult psychosocial crisis may result in sexual dysfunction. There may be both adult developmental deficits and regression to adolescent and adult stages previously negotiated. Both may be symptomatically represented by sexual dysfunction. The authors urge that the sexual and marital problems be evaluated within an adult developmental framework and that the therapy address the psychosocial issues which are appropriate to the developmental stage of the patient. PMID:3820320

Fagan, P J; Meyer, J K; Schmidt, C W

1986-01-01

314

The anatomy of group dysfunction.  

PubMed

The dysfunction of the radiology group has 2 components: (1) the thinking component-the governance structure of the radiology group; how we manage the group; and (2) the structural component-the group's business model and its conflict with the partner's personal business model. Of the 2 components, governance is more important. Governance must be structured on classic, immutable business management principles. The structural component, the business model, is not immutable. In fact, it must continually change in response to the marketplace. Changes in the business model should occur only if demanded or permitted by the marketplace; instituting changes for other reasons, including personal interests or deficient knowledge of the deciders, is fundamentally contrary to the long-term interests of the group and its owners. First, we must learn basic business management concepts to appreciate the function and necessity of standard business models and standard business governance. Peter Drucker's The Effective Executive is an excellent primer on the subjects of standard business practices and the importance of a functional, authorized, and fully accountable chief executive officer. PMID:24503047

Hayes, David F

2014-04-01

315

Flibanserin for female sexual dysfunction.  

PubMed

Hypoactive sexual desire disorder (HSDD) is the most commonly described form of female sexual dysfunction. There is currently no pharmacological therapy approved to treat HSDD, and therefore, there is an unmet medical need for the development of efficacious treatment alternatives. Flibanserin is a novel, non-hormonal drug for the treatment of HSDD in pre- and postmenopausal women, although the application submitted to the U.S. Food and Drug Administration by Sprout Pharmaceuticals is only for premenopausal women. Flibanserin works by correcting an imbalance of the levels of the neurotransmitters that affect sexual desire. More specifically, flibanserin increases dopamine and norepinephrine, both responsible for sexual excitement, and decreases serotonin, responsible for sexual inhibition. Clinically, flibanserin has exhibited some encouraging results in terms of its ability to increase the frequency of satisfying sexual events, and the intensity of sexual desire. However, adverse events such as dizziness, nausea, fatigue and somnolence, typical of a centrally acting drug, are also frequently related to flibanserin treatment. PMID:25187905

Reviriego, C

2014-08-01

316

Metabolic Syndrome and Erectile Dysfunction  

PubMed Central

OBJECTIVE To study the relation between metabolic syndrome (MS), cavernosal morphological vasculopathy, and peripheral vascular alterations (carotid and femoral wall) in patients with erectile dysfunction. RESEARCH DESIGN AND METHODS A total of 207 patients and 50 control subjects were evaluated for cardiovascular risk factors, physical examination, reproductive hormones, ultrasound analysis of cavernosal, carotid and femoral arteries (intima-media thickness), and cavernosal flow measurement (peak systolic velocity). RESULTS A total of 28% of patients had MS, and they presented with a high prevalence of cavernosal alterations (70.3%) and systemic vascular impairment (59.3%), whereas patients with cavernosal alterations (44%) showed the higher prevalence of MS (48.9%). The number of MS components was related to the prevalence of penile vasculopathy. However, multivariate analysis showed that MS is not an independent predictor for cavernosal vasculopathy. CONCLUSIONS Patients with cavernosal vasculopathy have an increased cardiometabolic risk, and screening for MS components might identify individuals with a higher risk for cavernosal and systemic atherosclerosis. PMID:21730283

Schipilliti, Mirko; Caretta, Nicola; Palego, Pierfrancesco; Selice, Riccardo; Ferlin, Alberto; Foresta, Carlo

2011-01-01

317

Tissue engineered bulking agent with adipose-derived stem cells and silk fibroin microspheres for the treatment of intrinsic urethral sphincter deficiency.  

PubMed

In this study we developed a tissue engineered bulking agent that consisted of adipose-derived stem cells (ADSCs) and silk fibroin microspheres to treat stress urinary incontinence caused by severe intrinsic sphincter deficiency (ISD). ISD models were established by completely transection of the bilateral pudendal nerve (PNT) and confirmed by the decreased leak-point pressure (LPP) and increased lumen area of urethra. Injection of silk fibroin microspheres could recover LPP and lumen area at 4 weeks but its efficacy disappears at 8, 12 weeks. Moreover, it was exciting to find that tissue engineered bulking agent brought long-term efficacy (at 4, 8, 12 weeks post-injection) on the recovery of LPP and lumen area. Concomitantly with the function, tissue engineered bulking agent treated group also improved the urethral sphincter structure as exhibited by better tissue regeneration. The findings showed that silk fibroin microspheres alone could work effectively in short-term, while tissue engineered bulking agent that combined silk fibroin microspheres with ADSCs exhibited promising long-term efficacy. This study developed a new strategy of tissue engineered bulking agent for future ISD therapy. PMID:24275524

Shi, Li Bing; Cai, Hong Xia; Chen, Long Kun; Wu, Yan; Zhu, Shou An; Gong, Xiao Nan; Xia, Ya Xian; Ouyang, Hong Wei; Zou, Xiao Hui

2014-02-01

318

PGC-1?, Mitochondrial Dysfunction and Huntington's Disease  

PubMed Central

The constant high energy demand of neurons makes them rely heavily on their mitochondria. Dysfunction of mitochondrial energy metabolism leads to reduced ATP production, impaired calcium buffering, and generation of reactive oxygen species. There is strong evidence that mitochondrial dysfunction results in neurodegeneration and may contribute to the pathogenesis of Huntington’s disease (HD). Studies over the past few years have implicated an impaired function of peroxisome proliferator-activated receptor (PPAR)-? coactivator-1? (PGC-1?), a transcriptional master co-regulator of mitochondrial biogenesis, metabolism and antioxidant defenses, in causing mitochondrial dysfunction in HD. Here we have attempted to discuss in a nutshell, the key findings on the role of PGC-1? in mitochondrial dysfunction in HD and its potential as a therapeutic target to cure HD. PMID:23602910

Johri, Ashu; Chandra, Abhishek; Beal, M. Flint

2013-01-01

319

Inflatable artificial sphincter  

MedlinePLUS

... perineal sling. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap ... in children. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap ...

320

Sexual dysfunction in the medically ill  

Microsoft Academic Search

Common in the medically ill, sexual dysfunction results from disruption of one or more stages of the sexual response cycle.\\u000a Increased understanding of sexual pathophysiology and the psychosocial forces whereby diseases impede normal function promotes\\u000a more informed treatment choices. This review focuses on the pathophysiology, impact, and treatment options of sexual dysfunction\\u000a in men and women with spinal cord injuries,

Kristin J. Somers; Kemuel L. Philbrick

2007-01-01

321

Telomere dysfunction induces metabolic and mitochondrial compromise  

Microsoft Academic Search

Telomere dysfunction activates p53-mediated cellular growth arrest, senescence and apoptosis to drive progressive atrophy and functional decline in high-turnover tissues. The broader adverse impact of telomere dysfunction across many tissues including more quiescent systems prompted transcriptomic network analyses to identify common mechanisms operative in haematopoietic stem cells, heart and liver. These unbiased studies revealed profound repression of peroxisome proliferator-activated receptor

Ergün Sahin; Simona Colla; Marc Liesa; Javid Moslehi; Florian L. Müller; Mira Guo; Marcus Cooper; Darrell Kotton; Attila J. Fabian; Carl Walkey; Richard S. Maser; Giovanni Tonon; Friedrich Foerster; Robert Xiong; Y. Alan Wang; Sachet A. Shukla; Mariela Jaskelioff; Eric S. Martin; Timothy P. Heffernan; Alexei Protopopov; Elena Ivanova; John E. Mahoney; Maria Kost-Alimova; Samuel R. Perry; Roderick Bronson; Ronglih Liao; Richard Mulligan; Orian S. Shirihai; Lynda Chin; Ronald A. Depinho

2011-01-01

322

Ejaculatory dysfunction as a cause of infertility  

Microsoft Academic Search

Ejaculatory dysfunction (EjD), the most prevalent male sexual disorder, is clearly different from erectile dysfunction (ED).\\u000a EjD is divided into 4 categories: premature ejaculation, delayed ejaculation, retrograde ejaculation and anejaculation. EjD-related\\u000a infertility is one of the most serious problems in young patients. If sexual intercourse is achieved successfully without\\u000a any ejaculate sexual partners\\/wives will not be able to conceive. Therefore,

Nobuyuki Kondoh

323

Current concepts in voiding dysfunction and dysfunctional voiding: A review from a urogynaecologist's perspective  

PubMed Central

Background: Female voiding dysfunction is a complex disorder, lacks definition, and is poorly understood and difficult to manage. Causes of Female Voiding Dysfunction: As there is no agreed classification of female voiding dysfunction, it is important to identify the several potential factors that might cause voiding dysfunction, namely anatomic, neurogenic, pharmacologic, endocrine, pharmacological and other causes. Presentation and Clinical Evaluation: Traditional and novel techniques are available and the importance and diagnostic dilemma related to these conditions need to be understood. We conclude by emphasizing the need to simplify the diagnosis and nomenclature of these conditions from a more clinical point of view as against an investigational perspective. PMID:25316994

Karmakar, Debjyoti; Sharma, Jai B

2014-01-01

324

Telomere dysfunction induces metabolic and mitochondrial compromise  

PubMed Central

Telomere dysfunction activates p53-mediated cellular growth arrest, senescence and apoptosis to drive progressive atrophy and functional decline in high-turnover tissues. The broader adverse impact of telomere dysfunction across many tissues including more quiescent systems prompted transcriptomic network analyses to identify common mechanisms operative in haematopoietic stem cells, heart and liver. These unbiased studies revealed profound repression of peroxisome proliferator-activated receptor gamma, coactivator 1 alpha and beta (PGC-1? and PGC-1?, also known as Ppargc1a and Ppargc1b, respectively) and the downstream network in mice null for either telomerase reverse transcriptase (Tert) or telomerase RNA component (Terc) genes. Consistent with PGCs as master regulators of mitochondrial physiology and metabolism, telomere dysfunction is associated with impaired mitochondrial biogenesis and function, decreased gluconeogenesis, cardiomyopathy, and increased reactive oxygen species. In the setting of telomere dysfunction, enforced Tert or PGC-1? expression or germline deletion of p53 (also known as Trp53) substantially restores PGC network expression, mitochondrial respiration, cardiac function and gluconeogenesis. We demonstrate that telomere dysfunction activates p53 which in turn binds and represses PGC-1? and PGC-1? promoters, thereby forging a direct link between telomere and mitochondrial biology. We propose that this telomere–p53–PGC axis contributes to organ and metabolic failure and to diminishing organismal fitness in the setting of telomere dysfunction. PMID:21307849

Sahin, Ergun; Colla, Simona; Liesa, Marc; Moslehi, Javid; Muller, Florian L.; Guo, Mira; Cooper, Marcus; Kotton, Darrell; Fabian, Attila J.; Walkey, Carl; Maser, Richard S.; Tonon, Giovanni; Foerster, Friedrich; Xiong, Robert; Wang, Y. Alan; Shukla, Sachet A.; Jaskelioff, Mariela; Martin, Eric S.; Heffernan, Timothy P.; Protopopov, Alexei; Ivanova, Elena; Mahoney, John E.; Kost-Alimova, Maria; Perry, Samuel R.; Bronson, Roderick; Liao, Ronglih; Mulligan, Richard; Shirihai, Orian S.; Chin, Lynda; DePinho, Ronald A.

2013-01-01

325

Telomere dysfunction induces metabolic and mitochondrial compromise.  

PubMed

Telomere dysfunction activates p53-mediated cellular growth arrest, senescence and apoptosis to drive progressive atrophy and functional decline in high-turnover tissues. The broader adverse impact of telomere dysfunction across many tissues including more quiescent systems prompted transcriptomic network analyses to identify common mechanisms operative in haematopoietic stem cells, heart and liver. These unbiased studies revealed profound repression of peroxisome proliferator-activated receptor gamma, coactivator 1 alpha and beta (PGC-1? and PGC-1?, also known as Ppargc1a and Ppargc1b, respectively) and the downstream network in mice null for either telomerase reverse transcriptase (Tert) or telomerase RNA component (Terc) genes. Consistent with PGCs as master regulators of mitochondrial physiology and metabolism, telomere dysfunction is associated with impaired mitochondrial biogenesis and function, decreased gluconeogenesis, cardiomyopathy, and increased reactive oxygen species. In the setting of telomere dysfunction, enforced Tert or PGC-1? expression or germline deletion of p53 (also known as Trp53) substantially restores PGC network expression, mitochondrial respiration, cardiac function and gluconeogenesis. We demonstrate that telomere dysfunction activates p53 which in turn binds and represses PGC-1? and PGC-1? promoters, thereby forging a direct link between telomere and mitochondrial biology. We propose that this telomere-p53-PGC axis contributes to organ and metabolic failure and to diminishing organismal fitness in the setting of telomere dysfunction. PMID:21307849

Sahin, Ergün; Colla, Simona; Liesa, Marc; Moslehi, Javid; Müller, Florian L; Guo, Mira; Cooper, Marcus; Kotton, Darrell; Fabian, Attila J; Walkey, Carl; Maser, Richard S; Tonon, Giovanni; Foerster, Friedrich; Xiong, Robert; Wang, Y Alan; Shukla, Sachet A; Jaskelioff, Mariela; Martin, Eric S; Heffernan, Timothy P; Protopopov, Alexei; Ivanova, Elena; Mahoney, John E; Kost-Alimova, Maria; Perry, Samuel R; Bronson, Roderick; Liao, Ronglih; Mulligan, Richard; Shirihai, Orian S; Chin, Lynda; DePinho, Ronald A

2011-02-17

326

Shockwave treatment of erectile dysfunction  

PubMed Central

Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED). Unlike other current treatment options for ED, all of which are palliative in nature, LI-ESWT is unique in that it aims to restore the erectile mechanism in order to enable natural or spontaneous erections. Results from basic science experiments have provided evidence that LI-ESWT induces cellular microtrauma, which in turn stimulates the release of angiogenic factors and the subsequent neovascularization of the treated tissue. Extracorporeal shock wave therapy (ESWT) has been clinically investigated and applied in several medical fields with various degrees of success. High-intensity shock wave therapy is used for lithotripsy because of its focused mechanical destructive nature, and medium-intensity shock waves have been shown to have anti-inflammatory properties and are used for treating a wide array of orthopedic conditions, such as non-union fractures, tendonitis, and bursitis. In contrast, LI-ESWT has angiogenetic properties and is therefore used in the management of chronic wounds, peripheral neuropathy, and in cardiac neovascularization. As a result of these characteristics we initiated a series of experiments evaluating the effect of LI-ESWT on the cavernosal tissue of patients with vasculogenic ED. The results of our studies, which also included a double-blind randomized control trial, confirm that LI-ESWT generates a significant clinical improvement of erectile function and a significant improvement in penile hemodynamics without any adverse effects. Although further extensive research is needed, LI-ESWT may create a new standard of care for men with vasculogenic ED. PMID:23554844

Appel, Boaz; Kitrey, Noam D.; Vardi, Yoram

2013-01-01

327

Thyroid dysfunction in Hodgkin's disease.  

PubMed

Radiotherapy to the neck and/or polychemotherapy late effects on the thyroid were investigated in 51 patients (34 males and 17 females) with Hodgkin's disease. Except for two untreated, recently diagnosed patients, all were studied after 1 to 105 months (median, 27.5 months) of completion of polychemotherapy. Age ranged from 6.2 to 36.6 years (median, 13.6 years). Patients were divided according to treatment into four groups: (A) patients treated with CVPP (cyclophosphamide, vinblastine, procarbazine, and prednisone); (B) 22 patients treated with CVPP plus radiotherapy (median radiation dose to the thyroid, 3000 cGy); (C) seven patients with ACOP/BVP (adriamycin, cyclophosphamide, vincristine, prednisone, bleomycin, vinblastine, procarbazine); and (D) seven patients treated with different polychemotherapy protocols, four of whom also received radiotherapy. Elevated basal and/or post-TRH, -TSH levels were found in the following: Group A: two of 12 patients (17%); Group B: 11 of 22 (50%); Group C: four of seven (57%); and Group D: two of seven (28%). Positive antimicrosomal thyroid antibody titers (AM Ab) were found in the following: Group A: three of 12 patients (25%); Group B: six of 21 (28%), Group C: two of seven (28%); and Group D: one of six (17%). Of 46 patients studied, 12 (26%) had positive AM Ab; 37 of 46 patients were younger than 20 years of age, 11 (30%) of whom had positive AM Ab versus 4% in the normal population (P less than 0.001). Two recently diagnosed, untreated patients had either high TSH response to TRH or positive AM Ab. In conclusion, higher frequency of thyroid dysfunction was observed in patients receiving radiotherapy (50% versus 27%). Prevalence of positive AM Ab, apparently unrelated to therapy, was higher in young patients than in the normal population. A predisposition to autoimmune thyroid disease seems to be present in these patients, but it is not possible to discern how lymphoma and thyroiditis are interrelated. PMID:2463071

Pasqualini, T; Iorcansky, S; Gruñeiro, L; Diez, B; Pavlovsky, S; Sackmann-Muriel, F; Rivarola, M A

1989-01-15

328

Assessment of Women With Defecatory Dysfunction and Manual Splinting Using Dynamic Pelvic Floor Magnetic Resonance Imaging  

PubMed Central

Objective This study aimed to describe magnetic resonance imaging (MRI) findings in women with defecatory dysfunction who perform manual splinting. Methods This is a retrospective study of 29 patients from a single urogynecology center who presented with complaints of defecatory dysfunction and who reported manual splinting to assist with bowel movements. Patients were scheduled for an MRI study with a novel “splinting” protocol to evaluate the effects of their manual splinting on the pelvic floor. The protocol involved asking patients to splint during the MRI, as they normally would when trying to defecate. The goal was to evaluate any change in pelvic anatomy and compensation for an anatomic defect that could potentially lead to their defecatory dysfunction. Magnetic resonance images of the pelvis were obtained at rest, with pelvic floor contraction, with Valsalva, and during manual splinting. These images were then reviewed by radiologists who evaluated various parameters, including anorectal angle, levator ani muscle integrity, and the presence of rectocele, cystocele, apical prolapse, and enterocele. The external and internal anal sphincters were also evaluated for continuity. Results From September 2008 to October 2010, 29 women reported defecatory dysfunction and the need for manual splinting. Their mean (SD) age was 55.2 (10.5) years. Magnetic resonance images showed a rectocele in 86.2% of the study group, cystocele in 75.9%, enterocele in 10.3%, and a defect of the levator ani muscles in 17.2%. Twentyone (72.4%) women had more than 1 of these defects. In addition, 27.6% had an anorectal angle less than 90 degrees or greater than 105 degrees. Patients in the study group splinted in the vagina (58.6%), on the perineum (31.0%), or on the buttock (10.3%). In all but 1 woman (96.6%), splinting improved or completely corrected the identified defect(s) as evidenced with MRI. Among those who used vaginal splinting, 52.9% of defects were corrected and 47.1% were improved. Perineal splinting corrected 55.6% and improved 33.3% of cases and was ineffective in 11.1% of cases, whereas buttock splinting corrected 33.3% and improved 66.7% of cases. Conclusions Most women in our study group who used manual splinting to assist in defecation are compensating for a pelvic floor defect that can be detected on MRI. Magnetic resonance imaging of the pelvis may help elucidate the etiology of the defecatory dysfunction in some women and may assist pelvic reconstructive surgeons in planning surgical correction of pelvic floor defects. Magnetic resonance imaging may also identify defects in the pelvic floor that are, at the present time, not amenable to surgical correction. PMID:22453259

Apostolis, Costas; Wallace, Karen; Sasson, Pierre; Hacker, Michele R.; Elkadry, Eman; Rosenblatt, Peter L.

2013-01-01

329

In Search of the Optimal Surgical Treatment for Velopharyngeal Dysfunction in 22q11.2 Deletion Syndrome: A Systematic Review  

PubMed Central

Background Patients with the 22q11.2 deletion syndrome (22qDS) and velopharyngeal dysfunction (VPD) tend to have residual VPD following surgery. This systematic review seeks to determine whether a particular surgical procedure results in superior speech outcome or less morbidity. Methodology/ Principal Findings A combined computerized and hand-search yielded 70 studies, of which 27 were deemed relevant for this review, reporting on a total of 525 patients with 22qDS and VPD undergoing surgery for VPD. All studies were levels 2c or 4 evidence. The methodological quality of these studies was assessed using criteria based on the Cochrane Collaboration's tool for assessing risk of bias. Heterogeneous groups of patients were reported on in the studies. The surgical procedure was often tailored to findings on preoperative imaging. Overall, 50% of patients attained normal resonance, 48% attained normal nasal emissions scores, and 83% had understandable speech postoperatively. However, 5% became hyponasal, 1% had obstructive sleep apnea (OSA), and 17% required further surgery. There were no significant differences in speech outcome between patients who underwent a fat injection, Furlow or intravelar veloplasty, pharyngeal flap pharyngoplasty, Honig pharyngoplasty, or sphincter pharyngoplasty or Hynes procedures. There was a trend that a lower percentage of patients attained normal resonance after a fat injection or palatoplasty than after the more obstructive pharyngoplasties (11–18% versus 44–62%, p?=?0.08). Only patients who underwent pharyngeal flaps or sphincter pharyngoplasties incurred OSA, yet this was not statistically significantly more often than after other procedures (p?=?0.25). More patients who underwent a palatoplasty needed further surgery than those who underwent a pharyngoplasty (50% versus 7–13%, p?=?0.03). Conclusions/ Significance In the heterogeneous group of patients with 22qDS and VPD, a grade C recommendation can be made to minimize the morbidity of further surgery by choosing to perform a pharyngoplasty directly instead of only a palatoplasty. PMID:22470558

Spruijt, Nicole E.; ReijmanHinze, Judith; Hens, Greet; Vander Poorten, Vincent; Mink van der Molen, Aebele B.

2012-01-01

330

Apraxia and Motor Dysfunction in Corticobasal Syndrome  

PubMed Central

Background Corticobasal syndrome (CBS) is characterized by multifaceted motor system dysfunction and cognitive disturbance; distinctive clinical features include limb apraxia and visuospatial dysfunction. Transcranial magnetic stimulation (TMS) has been used to study motor system dysfunction in CBS, but the relationship of TMS parameters to clinical features has not been studied. The present study explored several hypotheses; firstly, that limb apraxia may be partly due to visuospatial impairment in CBS. Secondly, that motor system dysfunction can be demonstrated in CBS, using threshold-tracking TMS, and is linked to limb apraxia. Finally, that atrophy of the primary motor cortex, studied using voxel-based morphometry analysis (VBM), is associated with motor system dysfunction and limb apraxia in CBS. Methods Imitation of meaningful and meaningless hand gestures was graded to assess limb apraxia, while cognitive performance was assessed using the Addenbrooke's Cognitive Examination – Revised (ACE-R), with particular emphasis placed on the visuospatial subtask. Patients underwent TMS, to assess cortical function, and VBM. Results In total, 17 patients with CBS (7 male, 10 female; mean age 64.4+/? 6.6 years) were studied and compared to 17 matched control subjects. Of the CBS patients, 23.5% had a relatively inexcitable motor cortex, with evidence of cortical dysfunction in the remaining 76.5% patients. Reduced resting motor threshold, and visuospatial performance, correlated with limb apraxia. Patients with a resting motor threshold <50% performed significantly worse on the visuospatial sub-task of the ACE-R than other CBS patients. Cortical function correlated with atrophy of the primary and pre-motor cortices, and the thalamus, while apraxia correlated with atrophy of the pre-motor and parietal cortices. Conclusions Cortical dysfunction appears to underlie the core clinical features of CBS, and is associated with atrophy of the primary motor and pre-motor cortices, as well as the thalamus, while apraxia correlates with pre-motor and parietal atrophy. PMID:24664085

Burrell, James R.; Hornberger, Michael; Vucic, Steve; Kiernan, Matthew C.; Hodges, John R.

2014-01-01

331

[Major depressive disorder, antidepressants and sexual dysfunction].  

PubMed

Depression and antidepressant therapy have been associated with sexual dysfunction. Studies report wide discrepancies with regard to frequency, gender, and quality of sexual dysfunction. Although sexual side effects are a common reason for non-compliance with medication, information on impairment of sexuality in psychiatric patients is rare. The impact of antidepressant- induced sexual dysfunction is substantial and negatively affects quality of life, self-esteem, mood, and relationship with partner. Sexual side effects resulting from serotonin specific reuptake inhibitors use may be mediated by a number of central and peripheral mechanisms. Some antidepressants such as Bupropion, mirtazapine, and moclobemide have a sexual tolerability profile significantly better than SSRIs, especially escitalopram, paroxetine, venlafaxine, sertraline, or fluoxetine. There are some possibilities for treatment of anti-depressant induced sexual dysfunctions such as waiting for spontaneous remission, reducing the dosage level, substituting the offending drug with other antidepressants, drug holidays, or administration of a phosphodiesterase- 5-inhibitor. These side-effects are increasingly used therapeutically in the context of the common male sexual dysfunction ejaculatio praecox. For this indication short-acting SSRI;s are available. PMID:19573505

Kinzl, Johann F

2009-01-01

332

Sexual dysfunction after cystectomy and urinary diversion.  

PubMed

Erectile dysfunction (ED) in men and sexual dysfunction in men and women are common after cystectomy and urinary diversion. Research has focused on both qualifying the prevalence of ED following cystectomy and identifying surgical approaches to limit sexual dysfunction after surgery, but most studies have been limited by small patient populations, an absence of control groups, and a lack of adjustment for confounding factors. Similarly, quality of life (QoL) research studies have also emerged in the context of bladder cancer and cystectomy, and increase our understanding of sexual outcomes associated with cystectomy. A number of instruments for collection of patient-reported outcomes among patients with bladder cancer treated with cystectomy are available for the assessment of condition-specific and procedure-specific QoL. However, other factors that negatively affect sexual function after removal of the bladder, such as psychological issues, age, and health-related competing risks for ED, body image, partner response, and change in life course and sexual priorities, have received less attention. Nevertheless, ED and sexual dysfunction are important complications of cystectomy and urinary diversion. Although changes in the approach to surgery, such as nerve-sparing cystectomy, might improve outcomes, evaluation and management of the source factors of ED and sexual dysfunction are necessary to optimize recovery of function. PMID:24980191

Modh, Rishi A; Mulhall, John P; Gilbert, Scott M

2014-08-01

333

The superior laryngeal nerve: function and dysfunction.  

PubMed

Despite long-standing clinical interest in SLN dysfunction, most aspects of this entity continue to require clarification. The replacement of the laryngeal mirror by flexible fiberoptic and rigid rod-lens laryngoscopy (including stroboscopy) and the resulting improvement in laryngeal visualization and documentation of examination has not resulted in a better definition of characteristic signs. Symptoms are often vague, and most are shared with other voice disorders. Under the circumstances, there is good reason to suppose that SLN dysfunction yields a clinical picture at least as heterogeneous as recurrent laryngeal nerve injury and a good deal more subtle. Faced with significant inconsistencies in clinical presentation, the clinician is hard-pressed to draw conclusions regarding prevalence, patterns of dysfunction, natural history, treatment, and even about its overall significance. EMG. used judiciously and complemented by frequency range testing, seems to hold more promise as a means of reliable diagnosis than laryngoscopic examination and may serve to resolve some of the confusion surrounding SLN dysfunction. It is equally important that the otolaryngologist guard against falling into the easy habit of attributing vocal disturbance that cannot be otherwise explained to SLN dysfunction in the absence of EMG evidence. If ambiguities surrounding SLN paralysis and paresis are to be clarified, diagnostic rigor is essential. PMID:15062693

Sulica, Lucian

2004-02-01

334

Computer analysis of human esophageal peristalsis and lower esophageal sphincter pressure. II. An interactive system for on-line data collection and analysis.  

PubMed

A computer program has been written to directly read and analyze esophageal manometric tracings on-line using low-cost off-the-shelf microcomputer hardware. The system consists of an Apple IIe microcomputer and an Interactive Microwave Inc. ADALAB Data Acquisition System with an AI13 fast A/D Multiplexer. The primary program is in BASIC with ASSEMBLY language subroutines for data collection. Data are collected through the voltage output of a Hewlett-Packard recorder at 30 points per second on four channels for lower esophageal sphincter pressures (LESP) and three channels for peristaltic waves. Computer-determined values for LESP and wave parameters showed excellent correlation with mean values as read by five individuals experienced in esophageal manometry. PMID:3769705

Castell, J A; Castell, D O

1986-11-01

335

Neurophysiologic Testing in Neurogenic Bladder Dysfunction: Practical or Academic?  

Microsoft Academic Search

For the diagnosis of neurogenic bladder, in addition to clinical assessment, neurophysiologic testing may be useful. Neurophysiologic\\u000a tests are more useful in patients with sacral compared with suprasacral disorders. Anal sphincter electromyography (EMG) is\\u000a the most useful diagnostic test, particularly for focal sacral lesions and atypical parkinsonism. Another clinically useful\\u000a method that tests the sacral segments and complements EMG is

Simon Podnar

2010-01-01

336

Perineal hernia: a case of outlet dysfunction.  

PubMed

This article describes and discusses a successfully treated case of a primary posterior perineal hernia which is a rare cause of outlet dysfunction. A 46-year-old female patient had a 6 cm left para-anal protrusion and a 7-year history of outlet dysfunction. The perineal hernia orifice was closed via an abdominal approach using both a polypropylene mesh and a Parietex Composite Net. A rectopexy to the promontory of the sacrum was then performed. Moreover, after 6 months' follow-up, the patient presented a sense of incomplete evacuation and underwent a prolassectomy to treat a hidden rectal prolapse. This clinical case shows that the surgical treatment of a pelvic pathology can be successful for the correction of a serious functional defect such as outlet dysfunction. PMID:19391352

Succi, Lino; Ohazuruike, Nnawuihe Luca; Oliveri, Conchita Emanuela; Privitera, Antonino Carlo; Prumeri, Serafina; Politi, Antonino; Garufi, Antonio; Randazzo, Giuseppe

2009-01-01

337

Sexual dysfunction and the patient with burns.  

PubMed

Sexual dysfunction in patients with burns has received only limited attention in the literature on burn care. We present five patients with burns whose sexual dysfunction responded to an eclectic treatment approach. A more extensive discussion on the relationship between post-traumatic stress disorder, other psychopathology, and sexual dysfunction in patients with burn injuries is presented. Neuroendocrinological, psychopathologic, psychodynamic, and physiological mechanisms that may be at play in patients with burns are proposed. The possible impact of post-traumatic stress disorder on sexuality is discussed. The illustrated cases suggest that sexual side effects of psychotropics, although fairly common, should not get in the way of proper use of antidepressants and antianxiety medications during the initial phase of treatment. Psychotropic and other commonly used medications in patients with burns, and the possible mechanisms of actions on sexuality, are reviewed. PMID:9063786

de Rios, M D; Novac, A; Achauer, B H

1997-01-01

338

Postpartum thyroid dysfunction in Mid Glamorgan  

PubMed Central

A high prevalence of postpartum thyroid dysfunction has been reported in several countries, but there have been no systematic studies of its prevalence in Britain. Among a group of 901 consecutive, unselected pregnant women thyroid autoantibodies were detected in 117 (13%) at booking. The clinical course of postpartum thyroid dysfunction, factors associated with its development, and its likely prevalence were defined in 100 of these women with thyroid antibodies and 120 women with no such antibodies who were matched for age. None of the women had a history of autoimmune thyroid disease. Normal reference ranges for thyroid function during pregnancy and post partum were established in the 120 women negative for thyroid antibodies. On the basis of these observations postpartum thyroid dysfunction was observed in 49 (22%) of the 220 women studied, and the prevalence in the total group of 901 women was estimated to be 16·7%. Thyroid dysfunction, mainly occurring in the first six months post partum, was usually transient and included both destruction induced hyperthyroidism and hypothyroidism. The development of the syndrome was significantly related to smoking more than 20 cigarettes a day and the presence of thyroid microsomal autoantibodies at booking. Of the 16 women with a family history of thyroid disease in whom thyroid microsomal autoantibody activity was detectable at booking, 11 developed thyroid dysfunction. Age, parity, presence of goitre at presentation, duration of breast feeding, and the sex and birth weight of the infant were not associated with the development of postpartum thyroid dysfunction. The mood changes experienced by women post partum may in part be associated with altered thyroid function during this time. PMID:3124900

Fung, Hedy Y M; Kologlu, Minosh; Collison, Kate; John, R; Richards, C J; Hall, R; McGregor, A M

1988-01-01

339

Endothelial Dysfunction in Children Without Hypertension  

PubMed Central

Background: Endothelial dysfunction can develop in the context of both obesity and obstructive sleep apnea (OSA) in children. However, the potential interactions between OSA and obesity have not been defined. Methods: Children who were prepubertal and nonhypertensive were recruited. Endothelial function was assessed in a morning fasted state, using a modified hyperemic test involving cuff-induced occlusion of the radial and ulnar arteries, and blood was drawn for assessment of myeloid-related protein 8/14 (MRP8/14) levels using a commercial enzyme-linked immunosorbent assay. Overnight polysomnography defined the presence of OSA or absence of OSA (NOSA) in subjects investigated for sleep-disordered breathing. Anthropometric measurements were performed to assign subjects to obese (OB) and nonobese (NOB) categories. Results: Fifty-four children with OSA who were obese and nonobese (mean age, 7.90 ± 0.26 years; mean BMI z-score, 1.70 ± 0.3; obstructive apnea-hypopnea index [OAHI], 7.36 ± 1.09) were compared with 54 children without OSA who were obese and nonobese (mean age, 8.26 ± 0.24 years; mean BMI z-score, 1.41 ± 0.18; OAHI, 0.86 ± 0.07). Of those subjects, 62.5% of the OB-OSA category, 38.7% of the OB-NOSA category, and 20.0% of the NOB-OSA category had evidence of endothelial dysfunction, compared with 0.0% of the NOB-NOSA category (P < .01). The degree of endothelial dysfunction in all groups was associated with circulating MRP8/14 levels (r = 0.343, P < .001). Conclusions: Both obesity and OSA can independently increase the risk for endothelial dysfunction, and the concurrent presence of both markedly increases such risk. Although the mechanisms underlying endothelial dysfunction remain unclear, a potential role for MRP8/14 as an inflammatory biomarker of endothelial dysfunction is suggested. PMID:22030801

Kim, Jinkwan; Alotaibi, Wadha H.; Kheirandish-Gozal, Leila; Capdevila, Oscar Sans; Gozal, David

2012-01-01

340

[Minimal brain dysfunctions in young children].  

PubMed

Ninety-six children with the minimal brain dysfunctions aged under three were examined. Neurologic follow-up started from the neonatal period. Time course of neurologic syndromes, type of child's psychomotor development, electroencephalographic and neurosonographic data were assessed. Perinatal brain injuries were detected in 44 children, 52 developed no structural changes. Clinical signs of the hypertensive hydrocephalic syndrome were detected during the first year of life in 61 of the 96 infants. Electroencephalographic examination was carried out in 27 of these and the diagnosis was confirmed in 24. Benign forms of the hypertensive hydrocephalic syndrome observed since early childhood are the most characteristic signs of the developing minimal brain dysfunction. PMID:8311154

Litsev, A E

1993-01-01

341

Dysfunctional adaptive immunity during parasitic infections  

PubMed Central

Parasite-driven dysfunctional adaptive immunity represents an emerging hypothesis to explain the chronic or persistent nature of parasitic infections, as well as the observation that repeated exposure to most parasitic organisms fails to engender sterilizing immunity. This review discusses recent examples from clinical studies and experimental models of parasitic infection that substantiate the role for immune dysfunction in the inefficient generation and maintenance of potent anti-parasitic immunity. Better understanding of the complex interplay between parasites, host adaptive immunity, and relevant negative regulatory circuits will inform efforts to enhance resistance to chronic parasitic infections through vaccination or immunotherapy. PMID:24839433

Zander, Ryan A.; Butler, Noah S.

2014-01-01

342

Acquired cilia dysfunction in chronic rhinosinusitis  

PubMed Central

Background: Cilia are complex and powerful cellular structures of the respiratory mucosa that play a critical role in airway defense. Respiratory epithelium is lined with cilia that perform an integrated and coordinated mechanism called mucociliary clearance. Mucociliary clearance is the process by which cilia transport the mucus blanket overlying respiratory mucosa to the gastrointestinal tract for ingestion. It is the primary means by which the airway clears pathogens, allergens, debris, and toxins. The complex structure and regulatory mechanisms that dictate the form and function of normal cilia are not entirely understood, but it is clear that ciliary dysfunction results in impaired respiratory defense. Methods: A literature review of the current knowledge of cilia dysfunction in chronic rhinosinsusitis was conducted. Results: Ciliary dysfunction may be primary, the result of genetic mutations resulting in abnormal cilia structure, or, more commonly, secondary, the result of environmental, infectious, or inflammatory stimuli that disrupt normal motility or coordination. Patients with chronic rhinosinusitis (CRS) have been found to have impaired mucociliary clearance. Many biochemical, environmental, and mechanical stimuli have been shown to influence ciliary beat frequency, and common microbial pathogens of respiratory mucosa such as Pseudomonas aeruginosa and Haemophilus influenzae have developed toxins that appear to interrupt normal mucociliary function. Furthermore, inflammatory mediators known to be present in patients with CRS appear to impair secondarily mucociliary clearance. Conclusion: The goal of this article is to summarize the recent developments in the understanding of cilia dysfunction and mucociliary clearance in CRS. PMID:22391065

Gudis, David; Zhao, Ke-qing

2012-01-01

343

Scintigraphic Imaging of Paediatric Thyroid Dysfunction  

Microsoft Academic Search

Imaging of thyroid dysfunction is safe and clinically relevant in children. In congenital hypothyroidism (CH), thyroid imaging permits a precise characterization of the aetiology, which is important for genetic counselling and clinical management. CH may be due to thyroid dysgenesis (ectopia, hypoplasia and athyrosis) or occurs in eutopic glands. In the latter, hypothyroidism may be either transient, especially after iodine

J. Clerc; H. Monpeyssen; A. Chevalier; F. Amegassi; D. Rodrigue; F. A. Leger; B. Richard

2008-01-01

344

Dysfunctional beliefs and antisocial personality disorder  

Microsoft Academic Search

Beck identified dysfunctional beliefs associated with personality disorders and these form the basis of the Personality Belief Questionnaire (PBQ). The PBQ has not yet been empirically examined in relation to antisocial personality disorder (ASPD); here, we examined the associations between PBQ antisocial beliefs and ASPD diagnosis, identified using the International Personality Disorder Examination (IPDE). Adult male prisoners were grouped as

Mary McMurran; Gary Christopher

2008-01-01

345

SOMATOSENSORY DYSFUNCTION FOLLOWING ACUTE TRIMETHYLTIN EXPOSURE  

EPA Science Inventory

A variety of trimethyltin (TMT) -produced sensory and behavioral dysfunctions have been reported. In this study the functional integrity of the somatosensory system was evaluated. Animals were tested using three different measures prior to (day 0) and 1,4, and 16 days following d...

346

Lifestyle and testicular dysfunction: A brief update  

Microsoft Academic Search

The incidence of testicular cancer, cryptorchidism and defective spermatogenesis is increasing probably due to environmental and lifestyle-related factors. The aim of this review is to briefly describe and comment on the principal lifestyle factors. The recent findings that the electromagnetic waves following the use of the cell phone and the prolonged exposure to the noise stress cause relevant testicular dysfunction

Ashok Agarwal; Nisarg R. Desai; Riccardo Ruffoli; Angelo Carpi

2008-01-01

347

Role of Insulin Resistance in Endothelial Dysfunction  

PubMed Central

Insulin resistance is frequently associated with endothelial dysfunction and has been proposed to play a major role in cardiovascular diseases. Insulin exerts pro- and anti-atherogenic actions on the vasculature. The balance between nitric oxide (NO)-dependent vasodilator actions and endothelin-1- dependent vasoconstrictor actions of insulin is regulated by phosphatidylinositol 3-kinase-dependent (PI3K) - and mitogen-activated protein kinase (MAPK)-dependent signaling in vascular endothelium, respectively. During insulin-resistant conditions, pathway-specific impairment in PI3K-dependent signaling may cause imbalance between production of NO and secretion of endothelin-1 and lead to endothelial dysfunction. Insulin sensitizers that target pathway-selective impairment in insulin signaling are known to improve endothelial dysfunction. In this review, we discuss the cellular mechanisms in the endothelium underlying vascular actions of insulin, the role of insulin resistance in mediating endothelial dysfunction, and the effect of insulin sensitizers in restoring the balance in pro- and anti-atherogenic actions of insulin. PMID:23306778

Muniyappa, Ranganath; Sowers, James R.

2013-01-01

348

Treatment of erectile dysfunction with sildenafil  

Microsoft Academic Search

Objectives. To determine the efficacy of sildenafil for the treatment of erectile dysfunction (ED) in a clinical practice setting; to evaluate the correlation between patient and partner perceptions of treatment outcomes; and to assess the relation between the severity of ED and response to treatment.Methods. Among the first 100 men to receive sildenafil in a urology practice setting, 74 (mean

Leonard S Marks; Catherine Duda; Frederick J Dorey; Maria Luz Macairan; Paul Bryan Santos

1999-01-01

349

Erectile dysfunction in heart disease patients  

Microsoft Academic Search

Atherosclerosis is a general health problem that not only affects the coronary arteries but also (in men) the penile arteries, thus contributing to organic causes of erectile dysfunction (ED) in heart disease patients. These organic causes are intertwined with psychological and pharmacological causes because medication prescribed for heart disease patients may also cause ED. The incidence of ED after myocardial

I Sainz; J Amaya; M Garcia

2004-01-01

350

Endothelial Dysfunction in Chronic Inflammatory Diseases  

PubMed Central

Chronic inflammatory diseases are associated with accelerated atherosclerosis and increased risk of cardiovascular diseases (CVD). As the pathogenesis of atherosclerosis is increasingly recognized as an inflammatory process, similarities between atherosclerosis and systemic inflammatory diseases such as rheumatoid arthritis, inflammatory bowel diseases, lupus, psoriasis, spondyloarthritis and others have become a topic of interest. Endothelial dysfunction represents a key step in the initiation and maintenance of atherosclerosis and may serve as a marker for future risk of cardiovascular events. Patients with chronic inflammatory diseases manifest endothelial dysfunction, often early in the course of the disease. Therefore, mechanisms linking systemic inflammatory diseases and atherosclerosis may be best understood at the level of the endothelium. Multiple factors, including circulating inflammatory cytokines, TNF-? (tumor necrosis factor-?), reactive oxygen species, oxidized LDL (low density lipoprotein), autoantibodies and traditional risk factors directly and indirectly activate endothelial cells, leading to impaired vascular relaxation, increased leukocyte adhesion, increased endothelial permeability and generation of a pro-thrombotic state. Pharmacologic agents directed against TNF-?-mediated inflammation may decrease the risk of endothelial dysfunction and cardiovascular disease in these patients. Understanding the precise mechanisms driving endothelial dysfunction in patients with systemic inflammatory diseases may help elucidate the pathogenesis of atherosclerosis in the general population. PMID:24968272

Steyers, Curtis M.; Miller, Francis J.

2014-01-01

351

Chronic neck pain and masticatory dysfunction  

Microsoft Academic Search

Chronic nonspecific neck pain is a common problem in rheumatology and may resist conventional treatment. Pathophysiological links exist between the cervical spine and masticatory system. Occlusal disorders may cause neck pain and may respond to dental treatment. The estimated prevalence of occlusal disorders is about 45%, with half the cases being due to functional factors. Minor repeated masticatory dysfunction (MD)

Jean-François Catanzariti; Thierry Debuse; Bernard Duquesnoy

2005-01-01

352

Telomere Dysfunction: A Potential Cancer Predisposition Factor  

Microsoft Academic Search

Background: Genetic instability associated with telomere dysfunction (i.e., short telomeres) is an early event in tumori- genesis. We investigated the association between telomere length and cancer risk in four ongoing case-control studies. Methods: All studies had equal numbers of case patients and matched control subjects (92 for head and neck cancer, 135 for bladder cancer, 54 for lung cancer, and

Xifeng Wu; Christopher I. Amos; Yong Zhu; Hua Zhao; Barton H. Grossman; Jerry W. Shay; Sherry Luo; Waun Ki Hong; Margaret R. Spitz

2003-01-01

353

Drug-associated renal dysfunction and injury  

Microsoft Academic Search

Renal dysfunction and injury secondary to medications are common, and can present as subtle injury and\\/or overt renal failure. Some drugs perturb renal perfusion and induce loss of filtration capacity. Others directly injure vascular, tubular, glomerular and interstitial cells, such that specific loss of renal function leads to clinical findings, including microangiopathy, Fanconi syndrome, acute tubular necrosis, acute interstitial nephritis,

Ziauddin Ahmed; Devasmita Choudhury

2006-01-01

354

Vitreous growth hormone and visual dysfunction  

Microsoft Academic Search

Growth factors have been found in vitreous fluid, in which they regulate retinal function and provide markers of ocular dysfunction. Since growth hormone (GH) has recently been discovered in the vitreous of human eyes, the possibility that vitreal GH concentrations might differ in different ocular disease states was assessed. GH-immunoreactivity in the vitreous of cadaver controls and in the vitreous

Misagh Ziaei; Matthew Tennant; Esmond J. Sanders; Steve Harvey

2009-01-01

355

Hepatitis C Virus-Induced Mitochondrial Dysfunctions  

PubMed Central

Chronic hepatitis C is characterized by metabolic disorders and a microenvironment in the liver dominated by oxidative stress, inflammation and regeneration processes that lead in the long term to hepatocellular carcinoma. Many lines of evidence suggest that mitochondrial dysfunctions, including modification of metabolic fluxes, generation and elimination of oxidative stress, Ca2+ signaling and apoptosis, play a central role in these processes. However, how these dysfunctions are induced by the virus and whether they play a role in disease progression and neoplastic transformation remains to be determined. Most in vitro studies performed so far have shown that several of the hepatitis C virus (HCV) proteins localize to mitochondria, but the consequences of these interactions on mitochondrial functions remain contradictory, probably due to the use of artificial expression and replication systems. In vivo studies are hampered by the fact that innate and adaptive immune responses will overlay mitochondrial dysfunctions induced directly in the hepatocyte by HCV. Thus, the molecular aspects underlying HCV-induced mitochondrial dysfunctions and their roles in viral replication and the associated pathology need yet to be confirmed in the context of productively replicating virus and physiologically relevant in vitro and in vivo model systems. PMID:23518579

Brault, Charlene; Levy, Pierre L.; Bartosch, Birke

2013-01-01

356

Role of Mitochondrial Dysfunction in Insulin Resistance  

PubMed Central

Insulin resistance is characteristic of obesity, type 2 diabetes, and components of the cardiometabolic syndrome, including hypertension and dyslipidemia, that collectively contribute to a substantial risk for cardiovascular disease. Metabolic actions of insulin in classic insulin target tissues (eg, skeletal muscle, fat, and liver), as well as actions in nonclassic targets (eg, cardiovascular tissue), help to explain why insulin resistance and metabolic dysregulation are central in the pathogenesis of the cardiometabolic syndrome and cardiovascular disease. Glucose and lipid metabolism are largely dependent on mitochondria to generate energy in cells. Thereby, when nutrient oxidation is inefficient, the ratio of ATP production/oxygen consumption is low, leading to an increased production of superoxide anions. Reactive oxygen species formation may have maladaptive consequences that increase the rate of mutagenesis and stimulate proinflammatory processes. In addition to reactive oxygen species formation, genetic factors, aging, and reduced mitochondrial biogenesis all contribute to mitochondrial dysfunction. These factors also contribute to insulin resistance in classic and nonclassic insulin target tissues. Insulin resistance emanating from mitochondrial dysfunction may contribute to metabolic and cardiovascular abnormalities and subsequent increases in cardiovascular disease. Furthermore, interventions that improve mitochondrial function also improve insulin resistance. Collectively, these observations suggest that mitochondrial dysfunction may be a central cause of insulin resistance and associated complications. In this review, we discuss mechanisms of mitochondrial dysfunction related to the pathophysiology of insulin resistance in classic insulin-responsive tissue, as well as cardiovascular tissue. PMID:18309108

Kim, Jeong-a; Wei, Yongzhong; Sowers, James R.

2010-01-01

357

EAU Guidelines on Erectile Dysfunction: An Update  

Microsoft Academic Search

The introduction of new oral therapies has completely changed the diagnostic and therapeutic approach to erectile dysfunction. A panel of experts in this field has developed guidelines for the clinical evaluation and treatment based on the review of available scientific information.

Eric Wespes; Edouard Amar; Dimitrios Hatzichristou; Kosta Hatzimouratidis; Francesco Montorsi; John Pryor; Yoram Vardi

2006-01-01

358

Minimal Brain Dysfunction: Associations with Perinatal Complications.  

ERIC Educational Resources Information Center

Examined with over 28,000 7-year-old children whose mothers registered for prenatal care was the relationship between perinatal complications and such characteristics as poor school achievement, hyperactivity, and neurological soft signs associated with the diagnosis of minimal brain dysfunction (MBD). Ten perinatal antecedents were studied:…

Nichols, Paul L.

359

Effect of Common Visual Dysfunctions on Reading.  

ERIC Educational Resources Information Center

Six common visual dysfunctions are briefly explained and their relationships to reading noted: (1) ametropia, refractive error; (2) inaccurate saccades, the small jumping eye movements used in reading; (3) inefficient binocularity/fusion; (4) insufficient convergence/divergence; (5) heterophoria, imbalance in extra-ocular muscles; and (6)…

McPartland, Brian P.

1985-01-01

360

Feeding and Swallowing Dysfunction in Genetic Syndromes  

ERIC Educational Resources Information Center

Children with genetic syndromes frequently have feeding problems and swallowing dysfunction as a result of the complex interactions between anatomical, medical, physiological, and behavioral factors. Feeding problems associated with genetic disorders may also cause feeding to be unpleasant, negative, or even painful because of choking, coughing,…

Cooper-Brown, Linda; Copeland, Sara; Dailey, Scott; Downey, Debora; Petersen, Mario Cesar; Stimson, Cheryl; Van Dyke, Don C.

2008-01-01

361

Immunoglobulin therapy in idiopathic hypothalamic dysfunction.  

PubMed

Idiopathic hypothalamic dysfunction is a rare disorder presenting at age 3-7 years. Severe hypothalamic and brainstem dysfunction leads to death in 25% of patients. The disease is presumed to be autoimmune, or in some cases paraneoplastic. No successful treatment has been reported. Patient V. developed hyperphagia, hypersomnia, and extreme aggression at age 7 years, accompanied by episodes of hyperthermia, hypothermia, sinus bradycardia, hypernatremia, hyponatremia, persistent hyperprolactinemia, hypothyroidism, and growth-hormone deficiency. At age 9 years, a diagnosis of idiopathic hypothalamic dysfunction was rendered, and immunoglobulin therapy was commenced. Nine courses of immunoglobulins, at a dose of 2 g/kg every 4 weeks, were administered. Reproducible improvements in behavior and no further episodes of hyponatremia or hypernatremia and sinus bradycardia were evident. The endocrinologic abnormalities and poor thermoregulation remained. Administration of immunoglobulins during late stages of idiopathic hypothalamic dysfunction led to improvement in some but not all signs. Assuming an autoimmune basis for this disorder, treatment during early stages of disease should be more effective. To facilitate such early treatment, increased awareness of this disorder is necessary, to allow for early diagnosis. PMID:19664546

Huppke, Peter; Heise, Alexander; Rostasy, Kevin; Huppke, Brenda; Gärtner, Jutta

2009-09-01

362

Specific aspects of erectile dysfunction in endocrinology  

Microsoft Academic Search

Prominent diseases of the endocrine system, such as diabetes mellitus, hypogonadism, and hyperprolactinemia, may cause erectile dysfunction (ED). ED affects about 50% of male diabetic patients possibly due to the vascular and neuropathic complications. Metabolic control and selective phosphodiesterase type 5 inhibitors are therapies of choice for controlling ED. By correcting hypogonadism, testosterone levels are restored. This, and the use

J M Miralles-García; L C García-Díez

2004-01-01

363

Erectile Dysfunction - Impotence: Questions to Discuss with Your Doctor  

MedlinePLUS

... Health Men’s Health Heart & Circulatory Health contact us Erectile Dysfunction ? Impotence Questions to Discuss with Your Doctor: Do ... medications (prescription or over-the-counter)? Has your erectile dysfunction worsened since starting any new medications? What effect ...

364

Remediation of Coordination Deficits in Youth with Minimal Cerebral Dysfunction.  

National Technical Information Service (NTIS)

The research to develop an accurate assessment tool to diagnose minimal cerebral dysfunction in children discovered that the Devereaux Test of Extremity Coordination (DTEC) is able to discriminate between children with minimal brain dysfunction and 'norma...

G. E. DeHaven, J. D. Bruce, D. C. Bryan

1971-01-01

365

Disruption of Fusion Results in Mitochondrial Heterogeneity and Dysfunction*S  

E-print Network

potential, and de- creased cellular respiration. Disruption of OPA1 by RNAi also blocked all mitochondrial retained low levels of mitochondrial fusion and escaped major cellular dysfunction. Analysis cellular defects, including poor cell growth, widespread hetero- geneity of mitochondrial membrane

Chan, David

366

[The therapy of masticatory organ dysfunctions (CMD)].  

PubMed

The authors have been dealing with disorders of the masticatory organ (CMD) for several decades and they published their experience and summarized findings that they have gained from over 2,000 cases. They gave a summary of masticatory organ dysfunction diagnostics in 3rd issue of Fogorvosi Szemle in 2011. In their current paper they discuss the treatment of masticatory organ dysfunctions (CMD) according to the logic of diagnostic algorythm and they present it to the practising dentist. They would like to emphasize that it is not allowed to indicate any treatment especially an irreversible one, without a diagnosis. The cause of the disease can very often be identified or specified after the symptom relieving treatment. After summarizing the general treatment principles depending on the functional condition of the masticatory organ, they give a detailed explanation of systematic functional therapy, i.e., symptomatic treatment or medical treatment, physiotherapy, occlusal splint therapy and the definitive treatment that follows (such as occlusal adjustment, prosthetic rehabilitation, orthodontics and surgical intervention). They classify the occlusal instruments (splint), which are often misinterpreted or not used in the proper way in practice (and bibliography), according to indications. They outline some orthodontic anomalies in connection with the masticatory organ: on the one hand when the patient who undergoes an orthodontic treatment has a latent or manifest masticatory organ dysfunction (CMD), on the other hand when the dysfunction appears during the orthodontic treatment. Among the definitive treatment principles they emphasize the gnathological aspects of prosthetic rehabilitation. They draw attention to the maintenance therapy of patients suffering from masticatory organ dysfunction. PMID:24551958

Kiss, Géza; Pácz, Miklós; Kiss, Péter

2013-12-01

367

Autonomic nervous system dysfunction in Parkinson’s disease  

Microsoft Academic Search

Opinion statement  Autonomic nervous system (ANS) dysfunction is common in Parkinson’s disease (PD), affects 70% to 80% of patients, and causes\\u000a significant morbidity and discomfort. Autonomic nervous system dysfunction symptoms in PD include sexual dysfunction, swallowing\\u000a and gastrointestinal disorders, bowel and bladder abnormalities, sleep disturbances, and derangements of cardiovascular regulation,\\u000a particularly, orthostatic hypotension. Autonomic nervous system dysfunction in PD may be

Theresa A. Zesiewicz; Matthew J. Baker; Mervat Wahba; Robert A. Hauser

2003-01-01

368

Whiplash injury and oculomotor dysfunctions: clinical–posturographic correlations  

Microsoft Academic Search

Oculomotor dysfunctions are hidden causes of invalidity following whiplash injury. Many patients with whiplash injury grade II present oculomotor dysfunctions related to input disturbances of cervical or vestibular afferents. We used static posturography to investigate 40 consecutive patients with whiplash injury grade II and oculomotor dysfunctions. We demonstrated a relation between length and surface of body sway: the surface value

Roberto Storaci; Alessandro Manelli; Nicola Schiavone; Lucia Mangia; Giangiacomo Prigione; Simone Sangiorgi

2006-01-01

369

Therapeutic Strategies for Diastolic Dysfunction: A Clinical Perspective  

PubMed Central

Diastolic dysfunction, which is increasingly viewed as being influential in precipitating heart failure and determining prognosis, is often unrecognized and has therapeutic implications distinct from those that occur with systolic dysfunction. In this review, several therapeutic modalities including pharmacologic, nonpharmacologic, and surgical approaches for primary diastolic dysfunction and heart failure will be discussed. PMID:20661322

Oh, Jae K.

2009-01-01

370

Diagnostic evaluation of left-sided prosthetic heart valve dysfunction  

Microsoft Academic Search

Prosthetic heart valve (PHV) dysfunction is a rare, but potentially life-threatening, complication. In clinical practice, PHV dysfunction poses a diagnostic dilemma. Echocardiography and fluoroscopy are the imaging techniques of choice and are routinely used in daily practice. However, these techniques sometimes fail to determine the specific cause of PHV dysfunction, which is crucial to the selection of the appropriate treatment

Ricardo P. Budde; Petr Symersky; Renee B. van den Brink; Bas A. de Mol; Willem P. Mali; Lex A. van Herwerden; Steven A. Chamuleau; Jesse Habets

2011-01-01

371

10.1177/0897190003253959 ARTICLEHEATHER B. MILLER and JACQUELYN S. HUNTFEMALE SEXUAL DYSFUNCTION Female Sexual Dysfunction: Review of the  

E-print Network

for treatment of male erectile dysfunction has set the stage for more open discussion of female sexual10.1177/0897190003253959 ARTICLEHEATHER B. MILLER and JACQUELYN S. HUNTFEMALE SEXUAL DYSFUNCTION Female Sexual Dysfunction: Review of the Disorder and Evidence for Available Treatment Alternatives

Dever, Jennifer A.

372

ALS and Frontotemporal Dysfunction: A Review  

PubMed Central

Though once believed to be a disease that was limited to the motor system, it is now apparent that amyotrophic lateral sclerosis (ALS) may be associated with cognitive changes in some patients. Changes are consistent with frontotemporal dysfunction, and may range from mild abnormalities only recognized with formal neuropsychological testing, to profound frontotemporal dementia (FTD). Executive function, behavior, and language are the most likely areas to be involved. Screening helpful in detecting abnormalities includes verbal or categorical fluency, behavioral inventories filled out by the caregiver, and evaluation for the presence of depression and pseudobulbar affect. Patients with cognitive dysfunction have shortened survival and may be less compliant with recommendations regarding use of feeding tubes and noninvasive ventilation. Evolving knowledge of genetic and pathological links between ALS and FTD has allowed us to better understand the overlapping spectrum of ALS and FTD. PMID:22919484

Achi, Eugene Y.; Rudnicki, Stacy A.

2012-01-01

373

Transient renal dysfunction with reversible splenial lesion.  

PubMed

We report the case of a 6-month-old boy with transient renal dysfunction who had an intensified signal in the splenium of the corpus callosum on magnetic resonance imaging. He presented to hospital with fever and sudden disturbance of consciousness. Cerebrospinal fluid analysis did not show pleocytosis. The mild consciousness disturbance disappeared after 30?min, but the splenial signal persisted even after 8 days. Further, renal glucosuria, increased excretion of select amino acids, and abnormal fractional excretion of electrolytes were observed, indicating renal tubular dysfunction. The abnormal urinary findings spontaneously resolved by day 9 of hospitalization. The splenial lesion took 21 days to normalize. There were no signs of neurological complications 2 months later. This case suggests the possibility of renal involvement in splenial lesions. PMID:25336014

Watanabe, Toru; Matsuda, Tomoka; Kitagata, Ryoichi; Tajima, Iwao; Ono, Hiroyuki; Hirano, Keiko; Shirai, Masami; Endoh, Akira; Hongo, Teruaki

2014-10-01

374

?-Synuclein and Mitochondrial Dysfunction in Parkinson's Disease  

PubMed Central

?-Synuclein (SNCA) is a substantive component of Lewy bodies, the pathological hallmark of Parkinson’s disease (PD). The discovery and subsequent derivation of its role in PD has led to a suprising but fruitful convergence of the fields of biochemistry and molecular genetics. In particular, the manipulation of the cell lines of a number of forms of familial PD has implicated SNCA in distinct and diverse biochemical pathways related to its pathogenesis. This current and rapidly evolving concept indicates PD is a disease in which interacting pathways of oxidative stress, mitochondrial dysfunction and impaired regulation of protein turnover interact to cause dopaminergic cell dysfunction and death. SNCA has a central role in these processes and manipulation of its expression, degradation and aggregation appear to be promising neuroprotective therapeutic targets. PMID:23361255

Mullin, Stephen; Schapira, Anthony

2014-01-01

375

Mitochondrial dysfunction and neurodegeneration in multiple sclerosis  

PubMed Central

Multiple sclerosis (MS) has traditionally been considered an autoimmune inflammatory disorder leading to demyelination and clinical debilitation as evidenced by our current standard anti-inflammatory and immunosuppressive treatment regimens. While these approaches do control the frequency of clinical relapses, they do not prevent the progressive functional decline that plagues many people with MS. Many avenues of research indicate that a neurodegenerative process may also play a significant role in MS from the early stages of disease, and one of the current hypotheses identifies mitochondrial dysfunction as a key contributing mechanism. We have hypothesized that pathological permeability transition pore (PTP) opening mediated by reactive oxygen species (ROS) and calcium dysregulation is central to mitochondrial dysfunction and neurodegeneration in MS. This focused review highlights recent evidence supporting this hypothesis, with particular emphasis on our in vitro and in vivo work with the mitochondria-targeted redox enzyme p66ShcA. PMID:23898299

Su, Kimmy; Bourdette, Dennis; Forte, Michael

2013-01-01

376

The Penile Prosthesis Option for Erectile Dysfunction  

Microsoft Academic Search

\\u000a Erectile dysfunction (ED) treatment can be divided into three main categories. These are oral agents, intracavernosal and\\u000a intraurethral therapies, and local devices, such as vacuum and penile prosthesis. The first-line treatment for ED is oral\\u000a phosphodiesterase type 5 inhibitors (PDE5Is); second-line treatment options include any combination of intracavernosal agents,\\u000a such as papaverine, phentolamine, PGE1, or transurethral alprostadil. For this reason,

Fikret Erdemir; Andrew Harbin; Wayne J. G. Hellstrom

377

Aspirin Improves Endothelial Dysfunction in Atherosclerosis  

Microsoft Academic Search

Background—The beneficial effects of aspirin in atherosclerosis are generally attributed to its antiplatelet activities, but its influence on endothelial function remains uncertain. We hypothesized that a cyclooxygenase-dependent constricting factor contributes to the endothelial dysfunction in atherosclerosis and that its action can be reversed by aspirin. Methods and Results—In 14 patients with coronary atherosclerosis and 5 with risk factors, we tested

Syed Husain; Neil P. Andrews; David Mulcahy; Julio A. Panza; Arshed A. Quyyumi

2010-01-01

378

Endothelial Cell Dysfunction, Injury and Death  

Microsoft Academic Search

Vascular endothelial cells (ECs) perform a number of functions required to maintain homeostasis. Inflammation can cause EC\\u000a injury and death which disrupt these processes and result in endothelial dysfunction. Three common mediators of EC injury\\u000a in inflammation are macrophage-derived cytokines, such as tumour necrosis factor (TNF); neutrophil-generated reactive oxygen\\u000a species (ROS) and cytolytic T lymphocytes (CTL). Here we describe the

J. S. Pober; W. Min

379

Multiorgan dysfunction related to chronic ketamine abuse  

PubMed Central

Ketamine abuse is being increasingly reported worldwide. The drug can produce a dissociative state and hallucinations, making ketamine a favorite recreational agent among drug addicts. Chronic ketamine abuse can damage many organs, including the brain, heart, liver, gastrointestinal tract, and genitourinary system. We report a patient with chronic ketamine abuse who presented with severe cachexia, upper gastrointestinal involvement, hepatobiliary dysfunction, and acute kidney injury. PMID:24982568

Raj, Binu; Thomas, Sebastian; Hanna, Fahmy W.

2014-01-01

380

Lifestyle and testicular dysfunction: a brief update.  

PubMed

The incidence of testicular cancer, cryptorchidism and defective spermatogenesis is increasing probably due to environmental and lifestyle-related factors. The aim of this review is to briefly describe and comment on the principal lifestyle factors. The recent findings that the electromagnetic waves following the use of the cell phone and the prolonged exposure to the noise stress cause relevant testicular dysfunction in man or animals reinforce the hypothesis of the importance of lifestyle-related factors. PMID:18771892

Agarwal, Ashok; Desai, Nisarg R; Ruffoli, Riccardo; Carpi, Angelo

2008-10-01

381

Tadalafil in the treatment of erectile dysfunction  

Microsoft Academic Search

Oral phosphodiesterase-5 inhibitors have emerged as the preferred first-line treatment for erectile dysfunction worldwide\\u000a because of patient convenience, efficacy, and safety. Clinical trials have shown that tadalafil significantly enhances erectile\\u000a function across a wide range of etiologies and provides a prolonged period of effectiveness independent of food or alcohol.\\u000a In this review, the pharmacokinetic and pharmacodynamic characteristics, efficacy, and safety

Anthony J. Bella; Gerald B. Brock

2003-01-01

382

Treatment of Angina and Microvascular Coronary Dysfunction  

Microsoft Academic Search

Opinion statement  Microvascular coronary dysfunction (MCD) is an increasingly recognized cause of cardiac ischemia and angina that is diagnosed\\u000a more commonly in women. Patients with MCD present with the triad of persistent chest pain, ischemic changes on stress testing,\\u000a and no obstructive coronary artery disease on cardiac catheterization. Data from the National Heart, Lung, and Blood Institute–sponsored\\u000a Women’s Ischemia Syndrome Evaluation

Arang Samim; Lynn Nugent; Puja K. Mehta; Chrisandra Shufelt; C. Noel Bairey Merz

2010-01-01

383

Erectile dysfunction in the aging male  

Microsoft Academic Search

Erectile dysfunction (ED) affects a significant proportion of men, starting in middle age, with a substantial increase with\\u000a each passing decade of life. This troubling condition is often not addressed in the geriatric population because of the common\\u000a misconception that older men are no longer sexually active. Much of the literature regarding treatment of ED focuses on middle-aged\\u000a men; however,

Lizette J. Smith

2005-01-01

384

Hormonal Evaluation and Therapy in Erectile Dysfunction  

Microsoft Academic Search

\\u000a Although endocrine causes of erectile dysfunction (ED) have been well recognized for decades, historically there has been\\u000a little emphasis on endocrine evaluation or treatment for men with ED. Endocrine abnormalities as a cause or contributing factor\\u000a for ED are important to recognize since these may be associated with significant additional medical problems, and also because\\u000a correction of the endocrinopathy often

Sergio A. Moreno; Abraham Morgentaler

385

Dysfunctional attitudes in major depression. Changes with pharmacotherapy.  

PubMed

High levels of dysfunctional attitudes have been associated with greater severity of depression and poorer response to pharmacological treatment. The goal of our study was to examine this relationship and the changes in dysfunctional attitudes after treatment with fluoxetine, a relatively selective serotonin uptake inhibitor. Dysfunctional attitudes were evaluated with both the Cognitions Questionnaire (CQ) and the Dysfunctional Attitudes Scale (DAS) in 115 outpatients diagnosed as having major depressive disorder. After 8 weeks of treatment with fluoxetine, 67 of these patients again completed the DAS and the CQ. Dysfunctional attitudes were associated with depression severity both before and after treatment and decreased linearly with treatment of the depression. Negative thinking and dysfunctional attitudes, as measured by both DAS and CQ, were not predictive of the degree of improvement in depressive symptoms. These findings partly support a state-dependent interpretation of dysfunctional attitudes, and provide evidence of significant reductions in these attitudes after treatment with a serotonin uptake inhibitor. PMID:8277301

Fava, M; Bless, E; Otto, M W; Pava, J A; Rosenbaum, J F

1994-01-01

386

Addressing sexual dysfunction in colorectal cancer survivorship care  

PubMed Central

Despite the high prevalence of sexual dysfunction in survivors of colorectal cancer, studies have shown that patients and providers rarely discuss how these symptoms may be influencing overall quality of life. The type and severity of symptoms of sexual dysfunction can vary greatly depending on the type of colorectal cancer and treatment, and assessment of sexual dysfunction is key to understanding how patients may be affected by these symptoms. Although patients would like to discuss these issues with their provider, they are often reluctant to ask questions about sexual functioning during appointments. Likewise, health care providers may hesitate to address sexual dysfunction due to time limitations or lack of knowledge regarding treatment of sexual problems. Health care providers can facilitate discussion of sexual dysfunction by (I) assessing sexual functioning throughout treatment; (II) initiating discussions about symptoms of sexual dysfunction at each appointment; and (III) maintaining adequate referral resources for treatment of sexual dysfunction. PMID:25276411

Averyt, Jennifer C.

2014-01-01

387

Post-LASIK Tear Dysfunction and Dysesthesia  

PubMed Central

Symptoms of tear dysfunction after laser in situ keratomileusis (LASIK) occur in nearly all patients and resolve in the vast majority. Although dry eye complaints are a leading cause of patient discomfort and dissatisfaction after LASIK, the symptoms are not uniform, and the disease is not a single entity. Post-LASIK tear dysfunction syndrome or dry eye is a term used to describe a spectrum of disease encompassing transient or persistent post-operative neurotrophic disease, tear instability, true aqueous tear deficiency, and neuropathic pain states. Neural changes in the cornea and neuropathic causes of ocular surface discomfort may play a separate or synergistic role in the development of symptoms in some patients. Most cases of early post-operative dry eye symptoms resolve with appropriate management, which includes optimizing ocular surface health before and after surgery. Severe symptoms or symptoms persisting after 9 months rarely respond satisfactorily to traditional treatment modalities and require aggressive management. This review covers current theories of post-LASIK dry eye disease, pathophysiology, risk factors, and management options for this disease spectrum of post-LASIK tear dysfunction and neuropathic pain. PMID:20712970

NETTUNE, GREGORY R.; PFLUGFELDER, STEPHEN C.

2013-01-01

388

Hypothalamic dysfunction following whole-brain irradiation  

SciTech Connect

The authors describe 15 cases with evidence of hypothalamic dysfunction 2 to 9 years following megavoltage whole-brain x-irradiation for primary glial neoplasm. The patients received 4000 to 5000 rads in 180- to 200-rad fractions. Dysfunction occurred in the absence of computerized tomography-delineated radiation necrosis or hypothalamic invasion by tumor, and antedated the onset of dementia. Fourteen patients displayed symptoms reflecting disturbances of personality, libido, thirst, appetite, or sleep. Hyperprolactinemia (with prolactin levels up to 70 ng/ml) was present in all of the nine patients so tested. Of seven patients tested with thyrotropin-releasing hormone, one demonstrated an abnormal pituitary gland response consistent with a hypothalamic disorder. Seven patients developed cognitive abnormalities. Computerized tomography scans performed a median of 4 years after tumor diagnosis revealed no hypothalamic tumor or diminished density of the hypothalamus. Cortical atrophy was present in 50% of cases and third ventricular dilatation in 58%. Hypothalamic dysfunction, heralded by endocrine, behavioral, and cognitive impairment, represents a common, subtle form of radiation damage.

Mechanick, J.I.; Hochberg, F.H.; LaRocque, A.

1986-10-01

389

Sexual Dysfunction before and after Cardiac Rehabilitation  

PubMed Central

Background. The aim of this study was to assess sexual function before and after cardiac rehabilitation in relation to medical variables. Methods. Analysis of patients participating in a 12-week exercise-based outpatient cardiac rehabilitation program (OCR) between April 1999 and December 2007. Exercise capacity (ExC) and quality of life including sexual function were assessed before and after OCR. Results. Complete data were available in 896 male patients. No sexual activity at all was indicated by 23.1% at baseline and 21.8% after OCR, no problems with sexual activity by 40.8% at baseline and 38.6% after OCR. Patients showed an increase in specific problems (erectile dysfunction and lack of orgasm) from 18% to 23% (P < .0001) during OCR. We found the following independent positive and negative predictors of sexual problems after OCR: hyperlipidemia, age, CABG, baseline ExC and improvement of ExC, subjective physical and mental capacity, and sense of affiliation. Conclusions. Sexual dysfunction is present in over half of the patients undergoing OCR with no overall improvement during OCR. Age, CABG, low exercise capacity are independent predictors of sexual dysfunction after OCR. PMID:22110969

Schumann, Jörg; Zellweger, Michael J.; Di Valentino, Marcello; Piazzalonga, Simone; Hoffmann, Andreas

2010-01-01

390

Acute renal dysfunction in liver diseases  

PubMed Central

Renal dysfunction is common in liver diseases, either as part of multiorgan involvement in acute illness or secondary to advanced liver disease. The presence of renal impairment in both groups is a poor prognostic indicator. Renal failure is often multifactorial and can present as pre-renal or intrinsic renal dysfunction. Obstructive or post renal dysfunction only rarely complicates liver disease. Hepatorenal syndrome (HRS) is a unique form of renal failure associated with advanced liver disease or cirrhosis, and is characterized by functional renal impairment without significant changes in renal histology. Irrespective of the type of renal failure, renal hypoperfusion is the central pathogenetic mechanism, due either to reduced perfusion pressure or increased renal vascular resistance. Volume expansion, avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal impairment. Splanchnic vasoconstrictor agents, such as terlipressin, along with volume expansion, and early placement of transjugular intrahepatic portosystemic shunt (TIPS) may be effective in improving renal function in HRS. Continuous renal replacement therapy (CRRT) and molecular absorbent recirculating system (MARS) in selected patients may be life saving while awaiting liver transplantation. PMID:17948928

Betrosian, Alex P; Agarwal, Banwari; Douzinas, Emmanuel E

2007-01-01

391

Decreased motility of the lower esophageal sphincter in a rat model of gastroesophageal reflux disease may be mediated by reductions of serotonin and acetylcholine signaling.  

PubMed

To elucidate the altered function of the lower esophageal sphincter (LES) in gastroesophageal reflux disease (GERD), we evaluated the motility proximal to LES using force transducers, contraction and relaxation responses to neurotransmitters in LES strips, and gene expression of neurotransmitter receptors in GERD rats. Force transducers were applied to the proximal LES, and contraction of the LES was monitored during free moving. In addition, LES was isolated from sham-operated and GERD rats to investigate the LES function in an organ bath, and to determine gene expression. The in vivo motility proximal to LES (% motility index) in conscious rats was decreased by atropine treatment and increased by cisapride (5-HT(4) receptor agonist) treatment. Acetylcholine- and serotonin (5-HT)-induced LES contraction and sodium nitroprusside-induced relaxation in LES strips of GERD rats markedly decreased compared to sham-operated rats. The mRNA expressions of 5-HT(4) and muscarinic acetylcholine 3 receptors were significantly reduced in esophageal LES strips of GERD rats compared with sham-operated rats. Intraperitoneal administration of cisapride improves the erosive damage in the esophagus in GERD rats. It is suggested that the reduction of 5-HT-induced contraction in LES strips in GERD rats may be partly due to the decrease in 5-HT(4)-receptor activation. The reduction of LES function may be due to the decrease in neurotransmitters signal transduction, leading to the deterioration of histopathological damage in GERD. PMID:21532161

Saegusa, Yayoi; Takeda, Hiroshi; Muto, Shuichi; Oridate, Nobuhiko; Nakagawa, Koji; Sadakane, Chiharu; Nahata, Miwa; Harada, Yumi; Iizuka, Mizuki; Hattori, Tomohisa; Asaka, Masahiro

2011-01-01

392

All men with vasculogenic erectile dysfunction require a cardiovascular workup.  

PubMed

An association between erectile dysfunction and cardiovascular disease has long been recognized, and studies suggest that erectile dysfunction is an independent marker of cardiovascular disease risk. Therefore, assessment and management of erectile dysfunction may help identify and reduce the risk of future cardiovascular events, particularly in younger men. The initial erectile dysfunction evaluation should distinguish between predominantly vasculogenic erectile dysfunction and erectile dysfunction of other etiologies. For men believed to have predominantly vasculogenic erectile dysfunction, we recommend that initial cardiovascular risk stratification be based on the Framingham Risk Score. Management of men with erectile dysfunction who are at low risk for cardiovascular disease should focus on risk-factor control; men at high risk, including those with cardiovascular symptoms, should be referred to a cardiologist. Intermediate-risk men should undergo noninvasive evaluation for subclinical atherosclerosis. A growing body of evidence supports the use of emerging prognostic markers to further understand cardiovascular risk in men with erectile dysfunction, but few markers have been prospectively evaluated in this population. In conclusion, we support cardiovascular risk stratification and risk-factor management in all men with vasculogenic erectile dysfunction. PMID:24423973

Miner, Martin; Nehra, Ajay; Jackson, Graham; Bhasin, Shalender; Billups, Kevin; Burnett, Arthur L; Buvat, Jacques; Carson, Culley; Cunningham, Glenn; Ganz, Peter; Goldstein, Irwin; Guay, Andre; Hackett, Geoff; Kloner, Robert A; Kostis, John B; LaFlamme, K Elizabeth; Montorsi, Piero; Ramsey, Melinda; Rosen, Raymond; Sadovsky, Richard; Seftel, Allen; Shabsigh, Ridwan; Vlachopoulos, Charalambos; Wu, Frederick

2014-03-01

393

The nature of detrusor bladder neck dyssynergia in non-neurogenic bladder dysfunction.  

PubMed

There have been two major opinions on the pathology or nature of the bladder neck contracture. One is an organic fibrosis, and the other is an accentuated sympathetic nervous function, or detrusor bladder neck dyssynergia. The existence of active detrusor bladder neck dyssynergia in neurogenic bladder was reported in a urodynamical manner using microtip transducer catheters. However, it has not been confirmed whether or not detrusor bladder neck dyssynergia is responsible for bladder neck contracture in patient without neurogenic bladder. The present study was designed to determine by means of video urodynamic study whether or not bladder neck contracture would be of the same nature as detrusor bladder neck dyssynergia in non-neurogenic bladder subjects. The study included 32 male subjects of 16-84 years old (average 52.3): 17 bladder neck contracture subjects including 7 subjects associated with minimum complications (4 with trapped benign prostatic hyperplasia and 3 with incomplete neurological lesion) and 15 non-bladder neck contracture subjects (10 healthy volunteers, 2 chronic prostatitis, 3 prostatodynia). A 5-microtip transducer catheter was used to measure the pressure in the bladder and at the bladder neck, the external urethral sphincter and the bulbous urethra during voiding. Proper localization of the transducers was done with an image intensifier. Bladder outlet obstruction localized at the bladder neck (diameters smaller than 0.75 cm) on voiding cystourethrogram was defined as bladder neck contracture. Detrusor bladder neck dyssynergia was defined where pressures were higher at the level of bladder neck than in the bladder during detrusor contraction. An alpha-blocker, terazosin hydrochloride (0.5 mg, b.i.d., two weeks), was orally administered to subjects judged to have detrusor bladder neck dyssynergia by the above methods for the purpose of confirming whether detrusor bladder neck dyssynergia was really due to accentuated sympathetic nervous function. Detrusor bladder neck dyssynergia was found in seven cases with bladder neck contracture: 6 cases with bladder neck contracture with minimum complications and only 1 case with bladder neck contracture without complications (p < 0.01). Detrusor bladder neck dyssynergia was found at the beginning and ending of micturition, but not at maximum flow. In six cases with detrusor bladder neck dyssynergia, the condition disappeared after terazosin. In conclusion, detrusor bladder neck dyssynergia was not thought to be a major factor of voiding dysfunction in bladder neck contracture in non-neurogenic bladder. In the presence of sympathetic hyperactivity or in cases with increased number of alphareceptors, detrusor bladder neck dyssynergia occurs, being predominantly noted in trapped benign prostatic hyperplasia and neurological disorder patients. PMID:9406121

Yamanishi, T; Yasuda, K; Sakakibara, R; Hattori, T; Tojo, M; Ito, H

1997-10-13

394

Piracetam improves mitochondrial dysfunction following oxidative stress  

PubMed Central

Mitochondrial dysfunction including decrease of mitochondrial membrane potential and reduced ATP production represents a common final pathway of many conditions associated with oxidative stress, for example, hypoxia, hypoglycemia, and aging. Since the cognition-improving effects of the standard nootropic piracetam are usually more pronounced under such pathological conditions and young healthy animals usually benefit little by piracetam, the effect of piracetam on mitochondrial dysfunction following oxidative stress was investigated using PC12 cells and dissociated brain cells of animals treated with piracetam. Piracetam treatment at concentrations between 100 and 1000??M improved mitochondrial membrane potential and ATP production of PC12 cells following oxidative stress induced by sodium nitroprusside (SNP) and serum deprivation. Under conditions of mild serum deprivation, piracetam (500??M) induced a nearly complete recovery of mitochondrial membrane potential and ATP levels. Piracetam also reduced caspase 9 activity after SNP treatment. Piracetam treatment (100–500?mg?kg?1 daily) of mice was also associated with improved mitochondrial function in dissociated brain cells. Significant improvement was mainly seen in aged animals and only less in young animals. Moreover, the same treatment reduced antioxidant enzyme activities (superoxide dismutase, glutathione peroxidase, and glutathione reductase) in aged mouse brain only, which are elevated as an adaptive response to the increased oxidative stress with aging. In conclusion, therapeutically relevant in vitro and in vivo concentrations of piracetam are able to improve mitochondrial dysfunction associated with oxidative stress and/or aging. Mitochondrial stabilization and protection might be an important mechanism to explain many of piracetam's beneficial effects in elderly patients. PMID:16284628

Keil, Uta; Scherping, Isabel; Hauptmann, Susanne; Schuessel, Katin; Eckert, Anne; Muller, Walter E

2005-01-01

395

Corneal transparency: genesis, maintenance and dysfunction  

PubMed Central

Optimal vision is contingent upon transparency of the cornea. Corneal neovascularization, trauma and, surgical procedures such as photorefractive keratectomy and graft rejection after penetrating keratoplasty can lead to corneal opacification. In this article we identify the underlying basis of corneal transparency and factors that compromise the integrity of the cornea. With evidence from work on animal models and clinical studies, we explore the molecular mechanisms of both corneal avascularity and its dysfunction. We also seek to review therapeutic regimens that can safely salvage and restore corneal transparency PMID:19481138

Qazi, Yureeda; Wong, Gilbert; Monson, Bryan; Stringham, Jack

2009-01-01

396

Molecular Links between Mitochondrial Dysfunctions and Schizophrenia  

PubMed Central

Schizophrenia is a complex neuropsychiatric disorder with both neurochemical and neurodevelopmental components in the pathogenesis. Growing pieces of evidence indicate that schizophrenia has pathological components that can be attributable to the abnormalities of mitochondrial function, which is supported by the recent finding suggesting mitochondrial roles for Disrupted-in-Schizophrenia 1 (DISC1). In this minireview, we briefly summarize the current understanding of the molecular links between mitochondrial dysfunctions and the pathogenesis of schizophrenia, covering recent findings from human genetics, functional genomics, proteomics, and molecular and cell biological approaches. PMID:22358509

Park, Cana; Park, Sang Ki

2012-01-01

397

Introduction to multiple organ dysfunction and failure.  

PubMed

Multiple organ failure and multiple organ dysfunction syndrome (MODS) were first recognized as undesirable complications of advancements in emergency and critical care. MODS remains the leading cause of death and resource expenditure in human intensive care units. MODS has been documented in small animal veterinary patients raising similar concerns. The understanding of the pathogenesis of MODS has evolved from uncontrolled infection to uncontrolled inflammation. Management is primarily through supportive care, early and aggressive monitoring of organ function, and intensive care nursing. Tissue hypoxia, microvascular thrombosis, increased vascular permeability, and disrupted cell-cell communication are prominent features of MODS. PMID:21757086

Hackett, Timothy B

2011-07-01

398

Extrapyramidal dysfunction with cerebral arteriovenous malformations 1  

PubMed Central

Arteriovenous malformations have only rarely been implicated as a cause of basal ganglia dysfunction. In four instances where such a lesion was uncovered, abnormal involuntary movements were present. In two, tremor involving the contralateral limbs occurred, while in others the head and neck were involved in dystonic movements and posture. The clinical and angiographic characteristics of these four patients have been assessed and are presented in detail in this report. The possible mechanism by which arteriovenous malformations may disturb the internal circuitry of the basal ganglia and induce symptoms are discussed. Images PMID:4829531

Lobo-Antunes, Joao; Yahr, Melvin D.; Hilal, Sadek K.

1974-01-01

399

Roles of olfactory system dysfunction in depression.  

PubMed

The olfactory system is involved in sensory functions, emotional regulation and memory formation. Olfactory bulbectomy in rat has been employed as an animal model of depression for antidepressant discovery studies for many years. Olfaction is impaired in animals suffering from chronic stress, and patients with clinical depression were reported to have decreased olfactory function. It is believed that the neurobiological bases of depression might include dysfunction in the olfactory system. Further, brain stimulation, including nasal based drug delivery could provide novel therapies for management of depression. PMID:24879990

Yuan, Ti-Fei; Slotnick, Burton M

2014-10-01

400

Progressive language dysfunction and lobar atrophy.  

PubMed

The patterns of language disorder associated with 'progressive aphasia' due to lobar atrophy were compared with the language dysfunction of patients with dementia of frontal lobe type (DFT). The progressive aphasias were characterised primarily by impairment at the structural levels of language: phonology, grammar and semantics, whereas DFT was associated primarily with spontaneity and loss of generative capability. However, there was overlap in language symptomatology, particularly with progression of disease. The findings lend support to the argument that progressive aphasia and DFT represent different clinical manifestations of a common pathology, and form part of the spectrum of lobar atrophies. PMID:8401796

Snowden, J S; Neary, D

1993-01-01

401

The association of age of toilet training and dysfunctional voiding  

PubMed Central

Objective To determine whether age of toilet training is associated with dysfunctional voiding in children. Materials and methods We compared patients referred to the urologic clinics for voiding dysfunction with age-matched controls without urinary complaints. Characteristics including age and reason for toilet training, method of training, and encopresis or constipation were compared between both groups. Results Initiation of toilet training prior to 24 months and later than 36 months of age were associated with dysfunctional voiding. However, dysfunctional voiding due to late toilet training was also associated with constipation. Conclusion Dysfunctional voiding may be due to delayed emptying of the bowel and bladder by children. The symptoms of dysfunctional voiding are more common when toilet training early, as immature children may be less likely to empty in a timely manner, or when training late due to (or in association with) constipation. PMID:25328866

Hodges, Steve J; Richards, Kyle A; Gorbachinsky, Ilya; Krane, L Spencer

2014-01-01

402

Neuropsychological Dysfunction and Aggression Among Female Federal Inmates  

Microsoft Academic Search

In this study, the authors investigated the relationship between neuropsychological dysfunction and aggression in female inmates. Participants included 555 female inmates from two low-security federal institutions. Aggression was measured by the Buss-Perry Aggression Questionnaire-Short Form. Neuropsychological dysfunction was measured by the Neuropsychological Dysfunction scale of the Coolidge Axis II Inventory and questions on the Psychology Services Intake Questionnaire. Results indicate

Sarah W. Daoust; Ann B. Loper; Philip R. Magaletta; Pamela M. Diamond

2006-01-01

403

Diagnosis and management of endocrine disorders of erectile dysfunction.  

PubMed

Organic causes of erectile dysfunction with androgen deficiency may be associated with aging, systemic illness, and a number of specific endocrine disorders stemming from pituitary, thyroid, and adrenal dysfunction. Central hypogonadism is the main mechanism in the majority. Erectile dysfunction in diabetes mellitus is caused by chronic complications due to poor metabolic control. Diagnosis and management of these disorders are discussed, as is the need for tight glycemic control in men with diabetes. PMID:7483129

Zonszein, J

1995-11-01

404

Diagnosing erectile dysfunction could save your patient's life  

PubMed Central

Erectile dysfunction and coronary artery disease are increasingly recognized as different clinical manifestations of the same process. Because the smaller vessels of the penis may be affected by plaque burden much earlier than the larger coronary, internal carotid, and femoral arteries, men may present with symptoms of erectile dysfunction long before signs of cardiovascular disease manifest. This presents an opportunity for the urologist to not only treat the sexual dysfunction and uncover occult coronary disease, but also to screen for cardiac risk, as even men with mild arteriogenic erectile dysfunction may be at risk for cardiovascular disease.

Brock, Gerald

2014-01-01

405

Measurement of endothelial dysfunction via peripheral arterial tonometry predicts vasculogenic erectile dysfunction.  

PubMed

Endothelial cell dysfunction is associated with cardiovascular disease and vasculogenic erectile dysfunction (ED). Measured via peripheral artery tonometry (PAT), endothelial dysfunction in the penis is an independent predictor of future cardiovascular events. The aim of the study was to determine whether measurement of endothelial dysfunction differentiates men with vasculogenic ED identified by duplex ultrasound from those without. A total of 142 men were retrospectively assessed using patient history, penile duplex ultrasonography (US) and PAT (EndoPAT 2000). ED was self-reported and identified on history. Vasculogenic ED was identified in men who exhibited a peak systolic velocity (PSV) of ?25?cm?s(-1) at 15?min following vasodilator injection. The reactive hyperemia index (RHI), a measurement of endothelial dysfunction in medium/small arteries, and the augmentation index (AI), a measurement of arterial stiffness, were recorded via PAT. Penile duplex US was used to categorize men into those with ED (n=111) and those without ED (n=31). The cohort with ED had a PSV of 21±1?cm?s(-1) (left cavernous artery) and 22±1?cm?s(-1) (right cavernous artery). The control group without ED had values of 39±2?cm?s(-1) (left) and 39±2?cm?s(-1) (right). Given the potential for altered endothelial function in diabetes mellitus, we confirmed that hemoglobin A1c, urinary microalbumin and vibration pulse threshold were not different in men with vasculogenic ED and those without. RHI in patients with ED (1.85±0.06) was significantly decreased compared to controls (2.15±0.2) (P<0.05). The AI was unchanged when examined in isolation, and when standardized to heart rate. Measurement of endothelial function with EndoPAT differentiates men with vasculogenic ED from those without. RHI could be used as a non-invasive surrogate in the assessment of vasculogenic ED and to identify those patients with higher cardiovascular risk. PMID:24784889

Kovac, J R; Gomez, L; Smith, R P; Coward, R M; Gonzales, M A; Khera, M; Lamb, D J; Lipshultz, L I

2014-11-01

406

Chronic kidney disease and erectile dysfunction.  

PubMed

Erectile dysfunction (ED) is a common condition among male chronic kidney disease (CKD) patients. Its prevalence is estimated to be approximately 80% among these patients. It has been well established that the production of nitric oxide from the cavernous nerve and vascular endothelium and the subsequent production of cyclic GMP are critically important in initiating and maintaining erection. Factors affecting these pathways can induce ED. The etiology of ED in CKD patients is multifactorial. Factors including abnormalities in gonadal-pituitary system, disturbance in autonomic nervous system, endothelial dysfunction, anemia (and erythropoietin deficiency), secondary hyperparathyroidism, drugs, zinc deficiency, and psychological problems are implicated in the occurrence of ED. An improvement of general conditions is the first step of treatment. Sufficient dialysis and adequate nutritional intake are necessary. In addition, control of anemia and secondary hyperparathyroidism is required. Changes of drugs that potentially affect erectile function may be necessary. Further, zinc supplementation may be necessary when zinc deficiency is suspected. Phosphodiesterase type 5 inhibitors (PDE5Is) are commonly used for treating ED in CKD patients, and their efficacy was confirmed by many studies. Testosterone replacement therapy in addition to PDE5Is may be useful, particularly for CKD patients with hypogonadism. Renal transplantation may restore erectile function. ED is an early marker of cardiovascular disease (CVD), which it frequently precedes; therefore, it is crucial to examine the presence of ED in CKD patients not only for the improvement of the quality of life but also for the prevention of CVD attack. PMID:25374815

Suzuki, Etsu; Nishimatsu, Hiroaki; Oba, Shigeyoshi; Takahashi, Masao; Homma, Yukio

2014-11-01

407

Chronic kidney disease and erectile dysfunction  

PubMed Central

Erectile dysfunction (ED) is a common condition among male chronic kidney disease (CKD) patients. Its prevalence is estimated to be approximately 80% among these patients. It has been well established that the production of nitric oxide from the cavernous nerve and vascular endothelium and the subsequent production of cyclic GMP are critically important in initiating and maintaining erection. Factors affecting these pathways can induce ED. The etiology of ED in CKD patients is multifactorial. Factors including abnormalities in gonadal-pituitary system, disturbance in autonomic nervous system, endothelial dysfunction, anemia (and erythropoietin deficiency), secondary hyperparathyroidism, drugs, zinc deficiency, and psychological problems are implicated in the occurrence of ED. An improvement of general conditions is the first step of treatment. Sufficient dialysis and adequate nutritional intake are necessary. In addition, control of anemia and secondary hyperparathyroidism is required. Changes of drugs that potentially affect erectile function may be necessary. Further, zinc supplementation may be necessary when zinc deficiency is suspected. Phosphodiesterase type 5 inhibitors (PDE5Is) are commonly used for treating ED in CKD patients, and their efficacy was confirmed by many studies. Testosterone replacement therapy in addition to PDE5Is may be useful, particularly for CKD patients with hypogonadism. Renal transplantation may restore erectile function. ED is an early marker of cardiovascular disease (CVD), which it frequently precedes; therefore, it is crucial to examine the presence of ED in CKD patients not only for the improvement of the quality of life but also for the prevention of CVD attack. PMID:25374815

Suzuki, Etsu; Nishimatsu, Hiroaki; Oba, Shigeyoshi; Takahashi, Masao; Homma, Yukio

2014-01-01

408

Pelvic floor and sexual male dysfunction.  

PubMed

The pelvic floor is a complex multifunctional structure that corresponds to the genito-urinary-anal area and consists of muscle and connective tissue. It supports the urinary, fecal, sexual and reproductive functions and pelvic statics. The symptoms caused by pelvic floor dysfunction often affect the quality of life of those who are afflicted, worsening significantly more aspects of daily life. In fact, in addition to providing support to the pelvic organs, the deep floor muscles support urinary continence and intestinal emptying whereas the superficial floor muscles are involved in the mechanism of erection and ejaculation. So, conditions of muscle hypotonia or hypertonicity may affect the efficiency of the pelvic floor, altering both the functionality of the deep and superficial floor muscles. In this evolution of knowledge it is possible imagine how the rehabilitation techniques of pelvic floor muscles, if altered and able to support a voiding or evacuative or sexual dysfunction, may have a role in improving the health and the quality of life. PMID:23695397

Pischedda, Antonella; Fusco, Ferdinando; Curreli, Andrea; Grimaldi, Giovanni; Pirozzi Farina, Furio

2013-03-01

409

Dysfunctional health service conflict: causes and accelerants.  

PubMed

This article examines the causes and accelerants of dysfunctional health service conflict and how it emerges from the health system's core hierarchical structures, specialized roles, participant psychodynamics, culture, and values. This article sets out to answer whether health care conflict is more widespread and intense than in other settings and if it is, why? To this end, health care power, gender, and educational status gaps are examined with an eye to how they undermine open communication, teamwork, and collaborative forms of conflict and spark a range of dysfunctions, including a pervasive culture of fear; the deny-and-defend lawsuit response; widespread patterns of hierarchical, generational, and lateral bullying; overly avoidant conflict styles among non-elite groups; and a range of other behaviors that lead to numerous human resource problems, including burnout, higher staff turnover, increased errors, poor employee citizenship behavior, patient dissatisfaction, increased patient complaints, and lawsuits. Bad patient outcomes include decreased compliance and increased morbidity and mortality. Health care managers must understand the root causes of these problems to treat them at the source and implement solutions that avoid negative conflict spirals that undermine organizational morale and efficiency. PMID:22534973

Nelson, H Wayne

2012-01-01

410

Iatrogenic causes of salivary gland dysfunction  

SciTech Connect

Saliva is important for maintaining oral health and function. There are instances when medical therapy is intended to decrease salivary flow, such as during general anesthesia, but most instances of iatrogenic salivary gland dysfunction represent untoward or unavoidable side-effects. The clinical expression of the salivary dysfunction can range from very minor transient alteration in saliva flow to a total loss of salivary function. The most common forms of therapy that interfere with salivation are drug therapies, cancer therapies (radiation or chemotherapy), and surgical therapy. These therapies can affect salivation by a number of different mechanisms that include: disruption of autonomic nerve function related to salivation, interference with acinar or ductal cell functions related to salivation, cytotoxicity, indirect effects (vasoconstriction/dilation, fluid and electrolyte balance, etc.), and physical trauma to salivary glands and nerves. A wide variety of drugs is capable of increasing or decreasing salivary flow by mimicking autonomic nervous system actions or by directly acting on cellular processes necessary for salivation: drugs can also indirectly affect salivation by altering fluid and electrolyte balance or by affecting blood flow to the glands. Ionizing radiation can cause permanent damage to salivary glands, damage that is manifest as acinar cell destruction with subsequent atrophy and fibrosis of the glands. Cancer chemotherapy can cause changes in salivation, but the changes are usually much less severe and only transient. Finally, surgical and traumatic injuries interfere with salivation because of either disruption of gland innervation or gross physical damage (or removal) of glandular tissue (including ducts).

Schubert, M.M.; Izutsu, K.T.

1987-02-01

411

Restless Legs Syndrome and Erectile Dysfunction  

PubMed Central

Study Objectives: Dopaminergic hypofunction in the central nervous system may contribute to restless legs syndrome (RLS) and erectile dysfunction (ED). We therefore examined whether men with RLS have higher prevalences of ED. Design: RLS was assessed using a set of standardized questions. Men were considered to have RLS if they met 4 RLS diagnostic criteria recommended by the International RLS Study Group, and had restless legs ? 5 times/month. Erectile function was assessed by a questionnaire. Setting: Community-based. Participants: 23,119 men who participated in the Health Professional Follow-up Study free of diabetes and arthritis. Results Multivariate-adjusted odds ratios for ED were 1.16 and 1.78 (95% confidence interval: 1.4, 2.3; P trend < 0.0001) for men with RLS symptoms 5–14 times/mo, and 15+ times/mo, respectively, relative to those without RLS, after adjusting for age, smoking, BMI, antidepressant use, and other covariates. The associations between RLS and ED persisted in subgroup analysis according to age, obesity, and smoking status. Conclusions: Men with RLS had a higher likelihood of concurrent ED, and the magnitude of the observed association was increased with a higher frequency of RLS symptoms. These results suggest that ED and RLS share common determinants. Citation: Gao X; Schwarzschild MA; O'Reilly EJ; Wang H; Ascherio A. Restless legs syndrome and erectile dysfunction. SLEEP 2010;33(1):75-79. PMID:20120623

Gao, Xiang; Schwarzschild, Michael A.; O'Reilly, Eilis J.; Wang, Hao; Ascherio, Alberto

2010-01-01

412

Mitochondrial Dysfunction in Metabolic Syndrome and Asthma  

PubMed Central

Though severe or refractory asthma merely affects less than 10% of asthma population, it consumes significant health resources and contributes significant morbidity and mortality. Severe asthma does not fell in the routine definition of asthma and requires alternative treatment strategies. It has been observed that asthma severity increases with higher body mass index. The obese-asthmatics, in general, have the features of metabolic syndrome and are progressively causing a significant burden for both developed and developing countries thanks to the westernization of the world. As most of the features of metabolic syndrome seem to be originated from central obesity, the underlying mechanisms for metabolic syndrome could help us to understand the pathobiology of obese-asthma condition. While mitochondrial dysfunction is the common factor for most of the risk factors of metabolic syndrome, such as central obesity, dyslipidemia, hypertension, insulin resistance, and type 2 diabetes, the involvement of mitochondria in obese-asthma pathogenesis seems to be important as mitochondrial dysfunction has recently been shown to be involved in airway epithelial injury and asthma pathogenesis. This review discusses current understanding of the overlapping features between metabolic syndrome and asthma in relation to mitochondrial structural and functional alterations with an aim to uncover mechanisms for obese-asthma. PMID:23840225

Mabalirajan, Ulaganathan; Ghosh, Balaram

2013-01-01

413

Deconstructing Mitochondrial Dysfunction in Alzheimer Disease  

PubMed Central

There is mounting evidence showing that mitochondrial damage plays an important role in Alzheimer disease. Increased oxygen species generation and deficient mitochondrial dynamic balance have been suggested to be the reason as well as the consequence of Alzheimer-related pathology. Mitochondrial damage has been related to amyloid-beta or tau pathology or to the presence of specific presenilin-1 mutations. The contribution of these factors to mitochondrial dysfunction is reviewed in this paper. Due to the relevance of mitochondrial alterations in Alzheimer disease, recent works have suggested the therapeutic potential of mitochondrial-targeted antioxidant. On the other hand, autophagy has been demonstrated to play a fundamental role in Alzheimer-related protein stress, and increasing data shows that this pathway is altered in the disease. Moreover, mitochondrial alterations have been related to an insufficient clearance of dysfunctional mitochondria by autophagy. Consequently, different approaches for the removal of damaged mitochondria or to decrease the related oxidative stress in Alzheimer disease have been described. To understand the role of mitochondrial function in Alzheimer disease it is necessary to generate human cellular models which involve living neurons. We have summarized the novel protocols for the generation of neurons by reprogramming or direct transdifferentiation, which offer useful tools to achieve this result. PMID:23840916

Garcia-Escudero, Vega; Martin-Maestro, Patricia; Perry, George; Avila, Jesus

2013-01-01

414

Cognitive dysfunction after experimental febrile seizures.  

PubMed

While the majority of children with febrile seizures have an excellent prognosis, a small percentage are later discovered to have cognitive impairment. Whether the febrile seizures produce the cognitive deficits or the febrile seizures are a marker or the result of underlying brain pathology is not clear from the clinical literature. We evaluated hippocampal and prefrontal cortex function in adult rats with a prior history of experimental febrile seizures as rat pups. All of the rat pups had MRI brain scans following the seizures. Rats subjected to experimental febrile seizures were found to have moderate deficits in working and reference memory and strategy shifting in the Morris water maze test. A possible basis for these hippocampal deficits involved abnormal firing rate and poor stability of hippocampal CA1 place cells, neurons involved in encoding and retrieval of spatial information. Additional derangements of interneuron firing in the CA1 hippocampal circuit suggested a complex network dysfunction in the rats. MRI T2 values in the hippocampus were significantly elevated in 50% of seizure-experiencing rats. Learning and memory functions of these T2-positive rats were significantly worse than those of T2-negative cohorts and of controls. We conclude that cognitive dysfunction involving the hippocampus and prefrontal cortex networks occur following experimental febrile seizures and that the MRI provides a potential biomarker for hippocampal deficits in a model of prolonged human febrile seizures. PMID:19000675

Dubé, Céline M; Zhou, Jun-Li; Hamamura, Mark; Zhao, Qian; Ring, Alex; Abrahams, Jennifer; McIntyre, Katherine; Nalcioglu, Orhan; Shatskih, Tatiana; Baram, Tallie Z; Holmes, Gregory L

2009-01-01

415

Role of phospholipase A2 (group I secreted) in the genesis of basal tone in the internal anal sphincter smooth muscle.  

PubMed

The role of phospholipase A(2) (PLA(2)) in the genesis of basal tone in the internal anal sphincter (IAS) is not known. We determined the effects of PLA(2) and inhibitors on the basal tone and intraluminal pressures (IASP) in the rat IAS vs. rectal smooth muscles (RSM). In addition, we determined the correlations between the IAS tone, PLA(2) levels, and the actual enzymatic activity. Inhibition of PLA(2) by 4-bromophenacyl bromide (universal inhibitor of PLA(2)) and MJ33 [selective inhibitor of secreted isoform of PLA(2) (sPLA(2))] caused concentration-dependent decrease in the IAS tone and in the IASP. Maximal decreases in the IAS tone and IASP by 4-bromophenacyl bromide and MJ33 were 58.8 +/- 6.9 and 51.5 +/- 6.3%, and 66.7 +/- 5.1 and 79.8 +/- 8.2%, respectively. The sPLA(2) inhibitors were approximately 100 times more potent in decreasing the IASP than the mean blood pressure. Conversely, the selective inhibitors of the cytosolic and calcium-independent PLA(2) arachidonyl trifluoromethyl ketone and bromoenol lactone, respectively, produced no significant effect. The IAS had characteristically higher levels of sPLA(2) activity (26.5 +/- 4.9 micromol.min(-1).ml(-1)) vs. the RSM (3.2 +/- 0.4 micromol.min(-1).ml(-1)), and higher levels of sPLA(2) as shown by Western blot and RT-PCR. Interestingly, administration of sPLA(2) transformed RSM into the tonic smooth muscle like that of the IAS: it developed basal tone and relaxed in response to the electrical field stimulation. From the present data, we conclude that sPLA(2) plays a critical role in the genesis of tone in the IAS. PLA(2) inhibitors may provide potential therapeutic target for treating anorectal motility disorders. PMID:17717042

de Godoy, Márcio A F; Rattan, Satish

2007-11-01

416

Excitatory and inhibitory actions of pituitary adenylate cyclase-activating peptide (PACAP) in the internal anal sphincter smooth muscle: sites of actions.  

PubMed

Unlike its effects on the rest of the GI tract, the effects of pituitary adenylate cyclase-activating peptide (PACAP) on the internal anal sphincter (IAS) are not known. We examined the actions of PACAP-38 (here PACAP) and PACAP-27 on the basal IAS tone of circular smooth muscle strips before and after the administration of different neurohumoral antagonists. PACAP caused a concentration-dependent fall in the basal tone of the IAS. Interestingly, however, at higher concentrations, PACAP caused a biphasic response: an initial contraction followed by a relaxation. Both the contractile and the relaxant responses were insensitive to atropine, guanethidine, apamin or tetrodotoxin. Both the contractile and the relaxant effects were inhibited by PACAP 6-38 (a selective antagonist of PACAP), vasoactive intestinal polypeptide 10-28 (a vasoactive intestinal polypeptide antagonist) and PACAP tachyphylaxis. The nitric oxide synthase inhibitor Nomega-nitro-L-arginine attenuated the inhibitory but not the excitatory effect of PACAP. Conversely, the contractile but not the relaxant effect of PACAP on the IAS was nearly obliterated by the substance P antagonist spantide. The N-type Ca++-channel blocker omega-conotoxin caused significant suppression of both the contractile and the inhibitory actions of PACAP. We conclude that in the IAS, PACAP has a dual effect: a contraction followed by a relaxation. The contraction of IAS by PACAP is speculated to occur via the activation of PACAP receptor at the substance P-containing nerve terminals. PACAP-induced IAS relaxation, on the other hand, appears to be mediated in large part by its direct action at the smooth muscle cells and in part by its action at the nerve terminals of the myenteric inhibitory neurons. PMID:9353391

Rattan, S; Chakder, S

1997-11-01

417

Correlation in Rectal Cancer Between Clinical Tumor Response After Neoadjuvant Radiotherapy and Sphincter or Organ Preservation: 10-Year Results of the Lyon R 96-02 Randomized Trial  

SciTech Connect

Purpose: To investigate, in rectal cancer, the benefit of a neoadjuvant radiation dose escalation with endocavitary contact radiotherapy (CXRT) in addition to external beam radiotherapy (EBRT). This article provides an update of the Lyon R96-02 Phase III trial. Methods and Materials: A total of 88 patients with T2 to T3 carcinoma of the lower rectum were randomly assigned to neoadjuvant EBRT 39 Gy in 13 fractions (43 patients) vs. the same EBRT with CXRT boost, 85 Gy in three fractions (45 patients). Median follow-up was 132 months. Results: The 10-year cumulated rate of permanent colostomy (CRPC) was 63% in the EBRT group vs. 29% in the EBRT+CXRT group (p < 0.001). The 10-year rate of local recurrence was 15% vs. 10% (p = 0.69); 10-year disease-free survival was 54% vs. 53% (p = 0.99); and 10-year overall survival was 56% vs. 55% (p = 0.85). Data of clinical response (CR) were available for 78 patients (36 in the EBRT group and 42 in the EBRT+CXRT group): 12 patients were in complete CR (1 patient vs. 11 patients), 53 patients had a CR {>=}50% (24 patients vs. 29 patients), and 13 patients had a CR <50% (11 patients vs. 2 patients) (p < 0.001). Of the 65 patients with CR {>=}50%, 9 had an organ preservation procedure (meaning no rectal resection) taking advantage of major CR. The 10-year CRPC was 17% for patients with complete CR, 42% for patients with CR {>=}50%, and 77% for patients with CR <50% (p = 0.014). Conclusion: In cancer of the lower rectum, CXRT increases the complete CR, turning in a significantly higher rate of long-term permanent sphincter and organ preservation.

Ortholan, Cecile [Department of Radiation Oncology, Antoine Lacassagne Cancer Center, Nice, UNSA (Universite de Nice Sophia-Antipolis) (France); Department of Oncology-Radiotherapy, Hopital Princesse Grace, Monaco (France); Romestaing, Pascale [Hopital Prive Jean Mermoz, Lyon (France); Chapet, Olivier [Department of Radiation Oncology, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon (France); Gerard, Jean Pierre, E-mail: jean-pierre.gerard@nice.unicancer.fr [Department of Radiation Oncology, Antoine Lacassagne Cancer Center, Nice, UNSA (Universite de Nice Sophia-Antipolis) (France)

2012-06-01

418

Mechano-transcription of COX-2 is a common response to lumen dilation of the rat gastrointestinal tract  

PubMed Central

Background In obstructive bowel disorders (OBDs) such as achalasia, pyloric stenosis, and bowel obstruction, the lumen of the affected segments is markedly dilated and the motility function is significantly impaired. We tested the hypothesis that mechanical stress in lumen dilation leads to induction of cyclo-oxygenase-2 (COX-2) in smooth muscle throughout the gastrointestinal (GI) tract, contributing to motility dysfunction. Methods Lumen dilation was induced in vivo with obstruction bands (12 × 3 mm) applied over the lower esophageal sphincter (LES), the pyloric sphincter, and the ileum in rats for 48 hr. Mechanical stretch in vivo was also emulated by balloon distension of the distal colon. Direct stretch of muscle strips from the esophagus, gastric fundus, and ileum was mimicked in an in vitro tissue culture system. Key Results Partial obstruction in the LES, pylorus, and ileum significantly increased expression of COX-2 mRNA and protein in the muscularis externae of the dilated segment oral to the occlusions, but not in the aboral segment. Direct stretch of the lumen in vivo or of muscle strips in vitro markedly induced COX-2 expression. The smooth muscle contractility was significantly suppressed in the balloon distended segments. However, treatment with COX-2 inhibitor NS-398 restored the contractility. Furthermore, in vivo administration of NS-398 in gastric outlet obstruction significantly improved gastric emptying. Conclusions & Inferences Mechanical dilation of the gut lumen by occlusion or direct distension induces gene expression of COX-2 throughout the GI tract. Mechanical stress-induced COX-2 contributes to motility dysfunction in conditions with lumen dilation. PMID:22489918

Lin, You-Min; Li, Feng; Shi, Xuan-Zheng

2014-01-01

419

Proverb comprehension impairments in schizophrenia are related to executive dysfunction  

Microsoft Academic Search

The study aimed to investigate the pattern of proverb comprehension impairment and its relationship to proverb familiarity and executive dysfunction in schizophrenia. To assess the specificity of the impairment pattern to schizophrenia, alcohol-dependent patients were included as a psychiatric comparison group, as deficits of executive function and theory of mind as well as dysfunction of the prefrontal cortex, which have

Patrizia Thoma; Marie Hennecke; Tobias Mandok; Alfred Wähner; Martin Brüne; Georg Juckel; Irene Daum

2009-01-01

420

Endothelium dysfunction classification: Why is it still an open discussion?  

Microsoft Academic Search

In the nineties, the present author developed a didactic endothelium dysfunction classification based on personal experience while waiting for a consensus about the need of such an accomplishment. As time went by and no publications regarding this subject were released, he published a text entitled “An open discussion about endothelial dysfunction: is it timely to propose a classification? Eight years

Paulo Roberto B. Evora; Caroline F. Baldo; Andrea Carla Celotto; Verena K. Capellini

2009-01-01

421

Corollary Discharge Dysfunction in Schizophrenia: Evidence for an Elemental Deficit  

Microsoft Academic Search

Evidence is accumulating that schizophrenia is characterized by dysfunction of efference copy\\/corollary discharge mechanisms that normally allow us to unconsciously recognize and disregard sensations resulting from our own actions. This dysfunction may give rise to subtle but pervasive sensory\\/perceptual aberrations in schizophrenic patients, altering their experience of their own overt and covert actions, as well as their interactions with the

Daniel H. Mathalon; Judith M. Ford

2008-01-01

422

Postoperative cognitive dysfunction after noncardiac surgery: effects of metabolic syndrome  

Microsoft Academic Search

Purpose Vascular risk factors, including metabolic syndrome, are known to contribute to the development of cognitive dysfunction. We tested the hypothesis that patients with metabolic syndrome are more likely to develop cognitive dysfunction after noncardiac surgery. Methods Age- and education-balanced patients (n = 60) undergoing elective noncardiac surgery with and without metabolic syndrome and 30 nonsurgical controls were enrolled. Recent verbal and

Judith A. HudetzKathleen; Kathleen M. Patterson; Oludara Amole; Aaron V. Riley; Paul S. Pagel

2011-01-01

423

Basicranial flexion, facial reduction and temporomandibular joint dysfunction  

Microsoft Academic Search

Although dysfunction is the major condition affecting the bilateral temporomandibular joint (TMJ), it has defied previous attempts to explain, predict, or prevent its clinical manifestations. A hypothesis is developed that there is an anatomical predisposition to TMJ dysfunction which should be sought in the phylogenetic flexing of the hominid basicranium. It is argued that the glenoid fossa, caught between an

J. A. Kieser

1997-01-01

424

Microcirculatory dysfunction in sepsis: a pathogenetic basis for therapy?  

Microsoft Academic Search

Sepsis is a frequent complication of multiple organ dysfunction syndrome and remains a major problem of intensive care medicine. It is also a common factor in the final cause of death in hospital populations. Clinical observations, assisted by invasive monitoring techniques as well as pathological-anatomical studies, clearly indicate that microcirculatory dysfunction lies at the centre of sepsis pathogenesis. Numerous animal

Fernando Bittinger; C. James Kirkpatrick

2000-01-01

425

Stroke: Bowel Dysfunction in Patients Admitted for Rehabilitation§  

PubMed Central

Aim : to assess the prevalence of diminished frequency of bowel movements, lumpy or hard stools, intestinal constipation, straining, incomplete evacuation, incontinence (bowel dysfunctions) in patients with brain injury resulting from cerebrovascular accident, either self-reported or reported by their caregivers; to describe the type and frequency of such dysfunctions; and the prevalence of laxative use both before and after stroke. Method : cross-sectional study with 98 hospitalized patients admitted for rehabilitation between December 2009 and May 2010. Results : the prevalence of bowel dysfunctions before stroke was 23.96% whereas after the lesion it was 55.21% (p<0.0001). As reported by patients/caregivers, the chances of developing bowel dysfunctions increase sevenfold after stroke, 95% CI (2.44-24.26). The most frequent dysfunctions before stroke were intestinal constipation (73.91%) and diminished frequency of bowel movements (17.39%). After stroke, constipation remains to be the most frequent dysfunction reported (50%), followed by diminished frequency of bowel movements (26.79%), incomplete evacuation (12.50%), and lack of privacy (5.36%). The use of laxatives was 19,15% after the lesion, but not statisticaly significant (p=0.0736). Conclusion : Bowel dysfunctions increases significantly after stroke. Therefore, further studies are needed to better understand and characterize such dysfunctions, which are scarcely described in the literature.

Engler, Tânia M.N. de M; Dourado, Cinthia C; Amâncio, Thais G; Farage, Luciano; de Mello, Paulo A.; Padula, Marcele P.C

2014-01-01

426

Sexual Dysfunction in Males: Significance of Adverse Childhood Experiences.  

ERIC Educational Resources Information Center

A survey of 301 male college students found that occasional sexual dysfunction was frequent in young male adults, and long-lasting adverse familial relationships to attachment figures were more influential in later sexual dysfunction than were childhood sexual abuse experiences. (Author/DB)

Kinzl, Johann F.; And Others

1996-01-01

427

Understanding dysfunctional leader-member exchange: antecedents and outcomes  

Microsoft Academic Search

Purpose – The purpose of this paper is to identify a number of limitations of the theory on leader-member exchange (LMX). This paper aims to argue that under certain conditions high quality LMX can be dysfunctional. It proceeds to identify the antecedents and outcomes of dysfunctional LMX. Design\\/methodology\\/approach – This paper examines the theory on LMX and justice to identify

Rozhan Othman; Foo Fang Ee; Ng Lay Shi

2010-01-01

428

Functional Urban Schools Amid Dysfunctional Settings: Lessons from South Africa  

ERIC Educational Resources Information Center

Similar to Dickens's "Tale of Two Cities", this research study is about a tale of two schools. The first type of school is a dysfunctional school. Dysfunctional schools are schools in a state of chaos (Shipengrower & Conway, 1998). The second school is that of order. The researchers refer to this school as a functional school.…

Mawdsley, Ralph D.; Bipath, Keshni; Mawdsley, James L.

2014-01-01

429

Erectile dysfunction, microangiopathy and UKPDS risk in type 2 diabetes  

Microsoft Academic Search

BackgroundErectile dysfunction (ED) is a frequent comorbidity in patients with type 2 diabetes mellitus (T2DM), and is now increasingly considered a surrogate marker of endothelial dysfunction as well as a sentinel predictor of new-onset macroangiopathic events. Less attention, however, has been directed at the potential association of ED and microangiopathy in hyperglycaemic states.

Michel P. Hermans; Sylvie A. Ahn; Michel F. Rousseau

2009-01-01

430

Linking endothelial dysfunction with endothelial cell activation  

PubMed Central

The thin layer of cells that lines the interior of blood vessels, known as the endothelium, plays a complex role in vascular biology. The endothelium mediates blood vessel tone, hemostasis, neutrophil recruitment, hormone trafficking, and fluid filtration. Endothelial dysfunction, as defined by a lack of NO, has been linked to a variety of disease states, including atherosclerosis, diabetes mellitus, coronary artery disease, hypertension, and hypercholesterolemia. Indeed, restoration of endothelial function is one of the earliest recognizable benefits of statin therapy. In 1995, James Liao and colleagues published a study in the JCI demonstrating that NO is a vascular protective factor that limits endothelial activation and prevents leukocyte adhesion to the vessel wall. PMID:23485580

Liao, James K.

2013-01-01

431

Role of Dendritic Cells in Immune Dysfunction  

NASA Technical Reports Server (NTRS)

The specific aims of the project were: (1) Application of the NASA bioreactor to enhance cytokine-regulated proliferation and maturation of dendritic cells (DC). (2) Compare the frequency and function of DC in normal donors and immunocompromised cancer patients. (3) Analyze the effectiveness of cytokine therapy and DC-assisted immunotherapy (using bioreactor-expanded DC) in a murine model of experimental fungal disease. Our investigations have provided new insight into DC immunobiology and have led to the development of methodology to evaluate DC in blood of normal donors and patients. Information gained from these studies has broadened our understanding of possible mechanisms involved in the immune dysfunction of space travelers and earth-bound cancer patients, and could contribute to the design of novel therapies to restore/preserve immunity in these individuals. Several new avenues of investigation were also revealed. The results of studies completed during Round 2 are summarized.

Savary, Cherylyn A.

1998-01-01

432

Treatment of Angina and Microvascular Coronary Dysfunction  

PubMed Central

Opinion statement Microvascular coronary dysfunction (MCD) is an increasingly recognized cause of cardiac ischemia and angina, more commonly diagnosed in women. Patients with MCD present with the triad of persistent chest pain, ischemic changes on stress testing, and no obstructive coronary artery disease (CAD) on cardiac catheterization. Data from National Heart, Lung and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study has shown that the diagnosis of MCD is not benign, with a 2.5% annual risk of adverse cardiac events including myocardial infarction, stroke, congestive heart failure, or death. The gold standard diagnostic test for MCD is an invasive coronary reactivity test (CRT), which uses acetylcholine, adenosine, and nitroglycerin to test the endothelial dependent and independent, microvascular and macrovascular coronary function. The CRT allows for diagnostic and treatment options as well as further risk stratifying patients for future cardiovascular events. Treatment of angina and MCD should be aimed at ischemia disease management to reduce risk of adverse cardiac events, ameliorating symptoms to improve quality of life, and to decrease the morbidity from unnecessary and repeated cardiac catheterization in patients with open coronary arteries. A comprehensive treatment approach aimed at risk factor managment, including lifestyle counseling regarding smoking cessation, nutrition and physical activity should be initiated. Current pharmacotherapy for MCD can include the treatment of microvascular endothelial dysfunction (statins, angiotensin-converting enzyme inhibitor, low dose aspirin), as well as treatment for angina and myocardial ischemia (beta blockers, calcium channel blockers, nitrates, ranolazine). Additional symptom management techniques can include tri-cyclic medication, enhanced external counterpulsation, autogenic training, and spinal cord stimulation. While our current therapies are effective in the treatment of angina and MCD, large randomized outcome trials are needed to optimize strategies to improve morbidity and mortality. PMID:20842559

Samim, Arang; Nugent, Lynn; Mehta, Puja K.; Shufelt, Chrisandra; Merz, C. Noel Bairey

2014-01-01

433

Monoaminergic dysfunction in recreational users of dexamphetamine.  

PubMed

Preclinical studies suggest that dexamphetamine (dAMPH) can lead to monoaminergic neurotoxicity. This exploratory study aimed to investigate effects of recreational dAMPH use on the dopamine (DA) and noradrenaline (NA) systems in humans. To that purpose, eight male abstinent dAMPH (26.0 ± 4.0 years) users and 10 age- and IQ-matched male healthy control subjects (23.0 ± 3.8) underwent neuropsychological testing sensitive to DAergic function and single photon emission computed tomography (SPECT) scanning with [(123)I]FP-CIT to determine striatal DA transporter (DAT) binding. In addition, changes in cerebral blood flow (CBF) induced by the DA/NA reuptake inhibitor methylphenidate (MPH) were measured using pharmacological magnetic resonance imaging (phMRI). Performance of dAMPH users was significantly worse on executive function and verbal memory tasks. Striatal DAT binding ratios were on average lower in dAMPH users (near-significant, p=0.05). In addition, CBF in control subjects decreased significantly in response to MPH in gray matter and basal ganglia, among which the striatum, thalamus and hippocampus by 10% to 29%. However, in dAMPH users the CBF response was blunted in most brain areas studied, only decreasing in the hippocampus and orbitofrontal cortex. When comparing groups, CBF response was found to be significantly different in the thalamus with a decrease for healthy controls and a blunted response in dAMPH users. Collectively, our findings of a blunted hemodynamic response in monoaminergic regions, in combination with indications for lower striatal DAT binding and poorer behavioral measures are likely to represent DAergic dysfunction in dAMPH users, although NAergic dysfunction may also play a role. PMID:23415394

Schouw, M L J; Caan, M W A; Geurts, H M; Schmand, B; Booij, J; Nederveen, A J; Reneman, L

2013-11-01

434

New directions for erectile dysfunction therapies.  

PubMed

Research in the field of erectile function and dysfunction has continued to expand rapidly. Based on the information available, some directions for future erectile dysfunction therapies can be identified. The first direction is improvement of current therapeutic principles. A second generation of orally active phosphodiesterase (PDE) inhibitors is being introduced, and further developments within this field can be expected. The recent introduction of apomorphine has opened the way for new dopamine receptor agonists. The second direction is combinations of existing therapeutic principles. Combinations of apomorphine and sildenafil and apomorphine and alpha(1)-adrenoceptor (AR) antagonists, for example, seem attractive and may have a therapeutic potential in patients not responding satisfactorily to single-drug treatment. Nitrosylated alpha(1)-AR antagonists, combining nitric oxide donation and alpha(1)- or alpha(2)-AR antagonism, are currently being evaluated. The third direction is new targets within the central nervous system. Melanocortin receptor agonists have shown promise not only in animal models, but also in preliminary studies in humans. Other possible targets, such as growth hormone-releasing peptide receptors, are being explored. The fourth direction is new peripheral targets. Rho-kinase antagonism and non-nitric oxide-mediated stimulation of soluble guanylyl cyclase have been suggested as possible new principles for drug development. The fourth direction is gene therapy. Progress has been made in intracavernosal somatic gene therapy and will probably continue. Still, problems remain, and advantages over conventional pharmacological therapies have to be demonstrated. The final direction is prevention strategies. Strategies to prevent cavernosal degeneration and/or to restore cavernosal function will be one of the most exciting challenges for future research. PMID:11850740

Andersson, K E; Hedlund, P

2002-02-01